Medical Billing

Processing, submitting and following upon claims with third party payers and/or patients for payment of the services rendered by the healthcare provider.

Training topics includes

Medical terminologies

Anatomy and physiology

Legal and regulatory issues

CMS-1500 claim form

ICD-9, ICD-10, HCPCS CODING, CPT

JOB RESPONSIBILITIES OF A MEDICAL BILLER

1.  Understand different types of insurance plans

2.  Applying payer policy-local and national determination (LCD/NCD) for successful claim submission

3.  Basic knowledge of coding guidelines

4.  Navigating through varying rules and regulations of health care industry

5.  Expertise in effective claim and patient follow up and denial resolution

STEPS INVOLVED IN MEDICAL BILLING SECTOR

  • Patient visits doctor

  • Doctor documents all conditions, diagnosis and procedures

  • Medical coder translates diagnosis and converts into ICD-10 and CPT codes according to the guidelines

  • After completion of this process, the medical coder enters the codes into a superbill or patient encounter form. After this step the patient encounter form passes to the medical biller

  • Medical biller submits the superbill to the patient or third party payer (medicare) for payment. The data is recorded into onto a CMS-1500 or UBO form and sent to the patient manually by mail or electronically

  • After the form has been submitted, the medical biller follow-up on outstanding and denied claims

LIKES AND DISLIKES ABOUT THIS JOB

Imagine if the claim is rejected they have to find out why and take necessary steps to solve the issue, therefore medical billers have to interact more with patients and insurance companies. A lot of times the claim also be denied because the medical coder do not code to the highest level of specificity. The chart is then sent back to medical coder to recode and the process starts all over again. This often causes mental stress for the billers currently working in a firm.

SALARY STATICS

The medical billing field expected to grow 21% between 2014 and 2020. A medical biller earns salary of 182,646 per year. People In the job generally don’t have more than 10 years of experience.