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Medical Billing is the Fastest Growing Opportunity in Health Care

by: Jay B Stockman

On February 16, 2006 the Health Insurance Portability and Accountability Act was finalized, and enacted. This law is designed to establish national standards for all health care transactions, and to ensure the security and privacy of all health related information. The motivation behind this law is to improve the performance, and efficiency of our health care system. This type of reform has created a need for qualified individuals who can utilize the tools of this legislation, and assure full compliance, and maximum reimbursement. It would therefore be a prudent move for health care facilities to employ such individuals in order to avoid mistakes that could have dire consequences.

The proliferation of medical knowledge following World War II brought about an explosion of diagnostic, and treatment procedures. As a result, there became a need to organize, and standardize all these developing technologies. Here is where the foundations of medical coding were born. Medical coding met these challenges, and allowed for a more uniform way of communicating health information under a common language. By January 1979, standardized definitions, and codes were adopted, and used by health care providers, and insurance companies. Since improvements and refinements of medical procedures are constantly being developed, codes must be added and updated to reflect these changes. Today, the number of medical and surgical procedures have become enormous, so too have the codes to describe them. These overwhelming numbers of codes and protocols have made outsourcing medical billing the standard.

Medical Billing and related occupations continue to be the fastest growing opportunities in health care. Insurance institutions and government agencies are investing huge resources to control claims� fraud, abuse, and establish some degree of reimbursement parity. As a result, more insurance companies, and health care facilities are looking

Today, evolutions in the health care industry are happening at a very high pace. It is only with the assistance of sophisticated computer programs, and standardized coding procedures that medical coders are now able to describe and characterize the tremendous number and various kinds of medical and surgical procedures.

to medical billing experts for help. These companies and practices are looking for experienced and educated individuals; the legal consequences of incorrect billing could be devastating. There is a movement in the industry to make medical billers responsible for inaccuracies, much they way accountants are for tax returns.

At present, there are no standards for educational requirements for medical billers and coders. However, more employers are looking for some formal training at an accredited career training institution. These schools range in training time from nine months to two years, anything less would not be considered adequate. There is a move for certification, and several organizations are sponsoring certification examinations in medical billing and coding. Medical billers and coders earn as much as $8 to $10 per hour in the beginning, and could potentially realize $30 to $40 per hours with experience and additional responsibilities.

Today, evolutions in the health care industry are happening at a very high pace. It is only with the assistance of sophisticated computer programs, and standardized coding procedures that medical coders are now able to describe and characterize the tremendous number and various kinds of medical and surgical procedures. These realities coupled with government regulations, and health insurance guidelines have contributed to the strong demand for experienced medical coders and billers.

About the Author

Jay B Stockman is a contributing editor for Medical Billing Resource. Visit http://all-medical-billing-software.com/ for more information.

Dr. Jay B Stockman is an individual contributor to Google Health Co-op

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The 9 Biggest Mistakes Every Medical Billing Office Should Avoid

By: David Duncan

The following information is crucial to the success of any medical billing office. Doctors simply do not pay enough attention to the admission/information gathering process. Receiving maximum reimbursement for your procedures is important; however one mistake in any of the following nine areas could result in NO payment whatsoever!

The biggest mistake I have experienced in over 15 years as the owner of a successful medical billing service, is the almost blind assumption by some physicians that their office manager ,"walks on water" and that billing staffers work hard and truly care about the practice. Assume the contrary or at a minimum look upon your staff with guarded optimism and you'll make a lot more money!

The second biggest mistake made by physicians is not taking a closer look at exactly what is being written off and why!

1. Always get a copy of the front and back of the patient's insurance card even if they're an existing patient. Never assume on follow-up visits that the patient is still covered under the same insurance plan. Make it a policy to assume they've changed insurances. Patients change insurance coverage all the time. Copying the insurance card will save you thousands of dollars per year and ultimately save, not cost your staff valuable time. Tracking patients down for missing information after the claim has already been filed is one of the most tedious and time-consuming tasks facing your billing office. Every time an initial claim goes out incorrectly you run the risk of a not being paid.

2. Verify benefits! Patients go in and out of coverage all the time. Their plans, in terms of deductibles and co-pays change all the time. Obviously the preauthorization process is quite time-consuming. It is not necessary to verify benefits in every circumstance such as follow-up care but I would recommend that you develop a reasonable policy and establish a timeframe for your verification of benefits process.

3. Post your e-mail address throughout your office. You probably won't have time to respond personally. But Read Them All! Have your IP professional program your e-mail client with a nicely crafted auto response. You'll be amazed at the valuable insight gained from reading the e-mails not to mention the positive impact it will have on your staff by ," keeping them on their toes."

4. Always obtain a second form of ID such as a driver's license from the patient. This information is very important especially if later on you experience collection problems. It's always best to assume that you will have future collection issues.

5. Always ask for the patient's work telephone number, cellular phone, pager and a relative's telephone number. This should be built into the encounter form. If the patient leaves it blank your staff should ask for additional phone numbers. This will also play a crucial role in the collection process later on. I cannot emphasize this fact enough. Plan for future collection and revenue related problems.

6. Always obtain authorization when necessary! Lack of authorization is probably the most commonly missed element in the billing process and it's a real income killer as well. Insurance companies deliberately make it difficult on your staff. Contact your provider service representative if you feel the carriers are taking advantage of the situation. Insurance companies are particularly notorious for denying," procedures" when performed on the same day as a consult or office visit. Many carriers expect a separate authorization number for procedures/injections performed on the same day as the office visit. Make sure your staff is familiar with which carriers require separate authorizations for procedures performed on the same day as the office visit.

7. Collect co-pays and deductibles at the time of service.

8. Secure sign Advanced Beneficiary Notice where indicated

9. Is the injury related to work or other type of accident? Many patients seeking medical services especially in the area of orthopedics and pain management have multiple injuries and are being treated for their injuries simultaneously. It is not uncommon for physicians to treat one part of the body which is work related and another from an automobile accident which is a completely separate situation. Your encounter form should have adequate fields for accident details.

I have yet to see a physician's medical billing office get this correct 100% of the time. I have a pain management practice that saved over $100,000 last year just by properly implementing step six.

Written by David Duncan President and founder of Medi-Bill Inc.

www.usemedibill.com

About the author:

David J. Duncan President and CEO

Mr. Duncan is a graduate of Florida Atlantic University with a B.A in Finance and is the original founder of Medi-Bill Inc. He also has an extensive law enforcement background and is a former police officer with the City of Fort Lauderdale. Mr. Duncan's reputation for honesty and integrity is well known throughout the medical community. During his career, Mr. Duncan has provided billing, financial and pract

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