What is Medical Billing Really Is & How to Do It?

What is Medical Billing Really Is & How to Do It?

Medical billing covers all the activities required for doctors or other healthcare practitioners to get paid by either the patient or reimbursed by an insurance carrier. Most apparently it involves the preparing of medical claims to be sent to health benefit payers such as Medicare, Medicaid, Blue Cross or Blue Shield, etc. 

Submitting medical claims to an insurance company and managing the overall claim process is more complicated than filing someone's Taxes; as there can be more than five different entities sharing the responsibility to pay for the medical treatment of a patient! 

While it can take time and experience to become a good medical biller, it's helpful if one begins with a clear grasp of what a 'Medical Biller' is supposed to do, and how they are supposed do it. This series of ten articles takes an in-depth view at how the best medical practices view, organize and execute the tasks associated with the entire medical billing process. For folks who like diagrams, here's a easy schematic depicting just how involved the whole medical billing revenue cycle can be

#1   Checking Eligibility #2   Understanding Coverage #3   Check-in (administrative) #4   Medical Coding Essentials #5   Sending Claims Electronically

#6   Revenue Cycle Management (RCM) #7   Follow-Up & Adjudication #8   Pay & Adjust, Secondary Claims #9   Denials & Appeals #10  Collections

# 1  Why Eligibility Verification Matters ?

As a Medical Biller, your objective in per-screening insurance eligibility is to determine patient responsibility before check-in; ideally, before the patient ever leaves their home to go to their medical appointment. You need to know what's covered and what's not, preferably before the patient arrives.

# 2   Benefits Coverage (for dummies)

Why does every single insurance carrier report different information and report it in a different format? Making sense of health insurance benefits means the difference between getting paid or not getting paid. Here we seek to unravel the mystery of understanding benefit eligibility reports.

# 3  Do's and Don'ts at Check-in / Handling Cash

So much can go so right, and so much can go so wrong, at check-in. Clear policies and adherence to those policies are the key to success. In good practices you'll see many common denominators. Here are a few of them.

# 4  Claim Preparation / Medical Coding / Coding Utilities

Nothing pays like experience and it is doubly true when you begin preparing claims for filing. Medical Coding is synonymous with who and what a medical biller is. Here are a few thoughts from veterans of the craft.

# 5 Filing Claims Electronically / Scrubbing for Errors

Everything you never wanted to know about claim transmittal and claim errors!

# 6 The Claims Have Been Sent, Now What?

Once a claim has been sent, it kicks off the revenue cycle and the sand of time begins running down the hour-glass. Here's the nuts and bolts of RCM, and how smart billers organize themselves and their tasks.

# 7  Adjudication, Follow Up, Submittable

Adjudication, insurance follow-up and avoiding claim resubmit, could be considered the necessary core competencies of a Medical Biller. Here's what all three are about and how to do them.

# 8 Payments, Adjustments, Secondary Claims

A Medical Biller needs to enter Payments & Adjustments as soon as payments come in so that Secondary claims can be filed in a timely manner. It also provides the practice with current status on patient balances and insurance balances, which is needed to manage cash flow.

# 9 In a Perfect World

Let's face it, insurance companies increase their profitability by denying claims and sometimes they'll deny them out-of-hand for no legitimate reason just to manage their cash-flow. So if you have a health benefit payer that insists on a fight, well then let's roll up our sleeves; here's what to do.

# 10  Patient Balances : Statements, Payment Arrangements, Collections

As a Medical Biller your aim is to avoid ever having unpaid patient balances in your account receivable reports, but in the real world, here's what to do when you inevitably get them, and expert advise on how to avoid them.