Understanding the Medical
Billing Industry
I'm sure you have read
the ad's and seen the pictures of mom's
holding their child on their lap while in
their pj's and how they can earn a lot of
money working from home? Is that possible?
Of course it is, is it likely? Not so much.
One thing I pride myself in is telling those
that want to break into this business is the
truth! YOU can't buy a software and expect
to make mountains of money without investing
not only money but a lot of time in learning
the industry and most important a foundation
of CONTINUED education. The health
insurance industry and medical billing
industry go hand-in-hand and are ever
changing. Federal and State regulations are
continuously changing and unless you are
prepared to continue education there is no
point in getting into this business.
One of the biggest questions
we get asked is: "Can I get started without
experience?" The answer is Yes and No.
Education is the key, if you are willing to
invest in learning the industry, learning
the very strict regulations, and have a
growing commitment to continued education,
then you can be very successful. Medical
billing is much more than just claims
filing, in order to be successful in an
overwhelmed industry the need by doctors is
much greater than it was 10 years ago. In
order to market your business you have to
educate providers on all the benefits of
outsourcing on top of marketing your
education and/or experience. That means you
need to be able to do MORE than just file
claims. The term medical billing in today's
industry is a term of the past. The more
proper description is "Full medical practice
management" which involves everything
from benefit verification to claims
follow-up, appeals, payment posting, patient
billing and providing your client with
precise and accurate reports on the health
of their practice. Basically you are
following every claim from beginning to end
(zero balance) this sounds easier said than
done. Let's look at the various elements of
what you need to provide your client with
these services:
-
Understanding the various types of
insurance plans available and being able
to differentiate each plan and how they
are constructed (HMO, PPO, Indemnity,
POS, Workers Compensation, Personal
Injury and MVA/No-F
ault insurance. To
name a few.
-
Understanding the importance of
patient's benefits and verifying those
benefits for new patients.
-
Understanding the importance of
obtaining and understanding managed care
authorizations and coverage limitations.
-
Understanding ICD9, CPT and HCPCS Coding
as well as identifying modifiers and
their various uses. Making sure you
purchase updated coding materials
yearly.
-
Understanding of Government Payers as
well as state and federal regulations
-
Understanding the various liabilities to
you and your business, protecting your
business with the appropriate insurance
coverage
-
Understanding and adhering to HIPAA
Regulations (Health Insurance
Portability and Accountability Act)
-
Understanding each element of electronic
claims filing.
-
Understanding the importance of the CMS
1500 form (universal health insurance
claim form)
-
Understanding the importance of a good
compliance plan as well as a policies
and procedures
-
Making sure you choose a software that
is compliant and constantly updated with
the industry standards
-
Choosing a clearinghouse that will also
grow with you and the industry.
-
Making
sure your office space is free from
prying eyes and adheres with HIPAA
privacy standards (locked filing
cabinets, computer access restricted to
only those with need to have access,
etc.)
-
Understanding the importance of
continued education (seminars,
association memberships, Continued
education via online or in-class
education
Those are just some of the things you will need to
become aware of if you are going to get into this business.
Hopefully by now you at least understand this business is more than
data entry and that many business opportunities and advertisements
make it look much easier than it really is. Having the education can
offset not having actual experience, but you must be willing to work
extra hard because remember you are dealing with the cash-flow of
your clients. While you save them money they expect an increase also
in their cash flow. Communicating with your clients is important too
because there are times you will be expected to educate them on
certain rules and regulations within the industry.
Check out the
"Start up Check List" to help
you get started on what you will need to begin.
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