Understanding the Medical Billing Industry

Medical billing translates a healthcare service into a billing claim. By just buying software one cannot get into the medical billing business and expect to make money without spending time in learning the industry. The medical billing and health insurance industry go hand-in-hand and are ever changing. Unless you are prepared to continue education there is no point in getting into the medical billing industry.

Medical billing is much more than just filing claims. Although a medical biller's duties vary with the size of the work facility, the biller typically assembles all data concerning the bill. This can include charge entry, claims transmission, payment posting, insurance follow-up, and providing precise and accurate reports on the health of their practice. If you plan to start in-house medical billing and want to be successful in an overwhelmed industry, you must know various factors you should be thorough with.

Let us look at the various factors of what a medical biller must do and understand:

  • Understanding the various types of insurance plans available and being able to differentiate each plan and how they are constructed
  • Understanding ICD-9, ICD-10 and CPT Coding
  • Understanding and adhering to HIPAA Regulations
  • Understanding the importance of patient's benefits and verifying those benefits along with eligibility for new patients
  • Understanding the importance of obtaining and understanding managed care authorizations and coverage limitations
  • Understanding Government Payers as well as state and federal regulations
  • Understanding all elements of electronic claims filing
  • Understanding the various liabilities to you and your business, protecting your business with the appropriate insurance coverage
  • Understanding compliance plans as well as policies and procedures
  • Understanding the importance of the practice management software and making sure it is updated to meet all new industry standards
  • Understanding the Affordable Care Act and how it relates to the medical billing industry
  • Understanding the potential necessity of becoming certified

These are just some of the factors you will need to become aware of it if you are going to get into this business. Hopefully by now you at least understand this business is more than just data entry. ┬áConcentrating on these factors may reduce your focus on your patients. This shows medical billing can be a demanding and challenging task for many medical practices. For this reason, many physicians or practice managers make the choice to outsource their medical billing to a professional medical billing company. How about you?

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