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Medical Billing - FAQs

What is the difference between electronic claims submission and billing?

Medical billing is a long process as compared to Electronic claims submission. Electronics claims submissions is a relatively smaller process where electronic claims are submitted in any readable format to the payer other than mailing a hard copy of the claim. Basically, electronic claim submission means filing claims electronically. These are sent to either insurance companies or to electronic claims clearinghouses that check the claims and clear them for payment by the insurance companies.
What are Differences Between Medical Coder's and Biller's Job?
Both of these jobs are often confused with each other. The medical coder primarily focuses on giving numbers or codes to a medical procedure, diagnosis or symptom to submit a claim for reimbursement. The medical biller makes sure that insurance companies and patients are billed correctly for all procedures and services provided by their health care provider. Medical Coders and Billers work hand in hand for speedy claim submission for insurance billing needs.
What does medical billing entail?

Medical billing is the process of billing patient visits to their physicians along with accounts receivable management functions for health care providers. This process is required both at a physician's private office and also in the hospitals. Every visit through a patient has to be billed to the insurance company and that's the work of a Billing Specialist. Billing the visit with the right code and filing the claims is what a medical biller does. A new career alongside of medical billing is "Health Insurance Specialist" who deals with understanding reimbursement criteria.

Is billing a viable home-based business?

Of course, it is. When you do an intensive search for home-based Billers, you will find them in plenty. Most of the specialist billers with enough of experience end up in setting their own business. Medical Billing should not be confused with electronic claims submission, which is another type of service that is also home-based.
What are the Traits of a Successful Medical Coding and Billing Specialist
Excellent organizational and marketing skills
Strong computer skills and technical knowledge
Good time management skills
Good business and work ethics.
How high is the demand for Medical Billers and Claims Processors?
Huge, one should say. There is an ever-growing demand for Medical Billers and Claims specialists. Filing claims electronically takes only couple of days as compared to a week with paper claims. As such there is always a demand for specialists in this field. Astonishingly, till today only 30-40% claims are filed electronically. Therefore, Billing and Coding Industry is wide open for everyone. Jobs are plentiful. 
Medical Billing - Is it the business for you?
Yes, it could be the ideal business for you only if you do not blindly follow the ads and claims by certain companies. Medical billing career and business is not that easy as claimed by many of them. It requires education, experience, contacts, business skills, marketing skills and certainly skills of a good medical billing specialist. So if you have those skills and if you are ready to invest your time and energy, go ahead. Get the right training and start with the hottest career of this decade!
Do I need to be certified?

It is not necessary to be certified to get a job as a medical billing specialist. However, more and more billers are getting certified these days. The ratio of certified Billers and Coders is on the rise and there is no doubt that certification increases the chances of getting a good job. So it is better to get certified in today's arena.
Is medical billing really going to be one of the "hottest home business opportunities" of the coming years?

Medical billing is a certainly hot career this time. Medical billing has good job prospects and it is one of the careers that will have ample growth opportunities and requirements for quite a long time. With most of Billers now choosing the home-based option, one can certainly say it is the Hottest Home Business.
Why don't doctors prefer to file and submit their own electronic claims?
Doctors would prefer to file their claims themselves, but as said earlier it is not an easy process. Any error could result in rejection of claims and coupled with the maintenance of account receivables, it becomes a tough task. They could very well utilize this time in examining more patients rather than involve their time in this job. As a matter of fact, filing their claims through a medical billing specialist has lots of advantages. It definitely reduces their overhead costs, reduces the hassles, and always provides them up-to-date information on account receivables.
Do I need to know medical terminology to do Medical Billing?
Not necessary! You do not need to know medical terminology to be a Medical Biller, though having such knowledge would definitely help. The codes that are used in Medical Billing are given by the physicians that you serve and your work becomes a lot easier. Even if the codes are not provided, you can always get the codes from software itself or from the ICD-9 and CPT4 code diskettes.
How much can I expect to earn?
Most of the medical Billers earn between $20,000 to $41,000 a year. It depends on how many clients you handle. The more clients you have, more will be your earnings. A rough estimation is around $4 per file submission. With around 5000 claims a year per doctor, this makes around $20,000 a year from one physician practice. Most Medical Billers serve 2-3 doctors with the most experience ones serving 5 doctors easily. This makes their earnings to go up to $100,000 a year.
What is a clearinghouse and how much will I have to pay them to submit and process claims? What could be my other expenses in Medical Claims Processing?
Miscellaneous expenses are postage, stationery, marketing, phone calls, software charges and Clearinghouse expenses. The Clearinghouses gather claims information electronically and then submits this information to insurance companies such as Medicare for payment. Clearinghouses have the ability to meet the specific requirements of each insurance company in their specific computer formats. Therefore, they are able to submit claims to any insurance company that accepts electronic claims. Their charges vary from $0.30 to $0.50 fee per claim filed. Most of them are not charging their setup charges now but some still charge.
When should I send new billing information?
Daily, if possible. Depending on the practice you serve, you can always change your file submission schedule. Some of them require you to send information daily while some require it weekly. It's always better to be quick and fast in submitting a claim.
How are non-payments handled?
That’s a big question. Well, if there are no payments after 4 or 5 statements, the accounts are handed over to the collection agency who are expert in recovering those payments.
Do you have to collect every co-payment?
Definitely, Yes. By law, you have to collect the co-payment from every patient.
How do you get paid in medical billing?

It depends on the mode of work you chose. The most preferred one is salary based where you work certain hours and get your regular paycheck. The other way is to charge commission or certain percentage of the total collected revenue by your medical practice. Depending on what better suits you, you can decide which way to pursue the career. However, in electronic claims submission, you can only charge by the claim and the processing fee to the Clearinghouse has to be paid by you.
Common Medical Billing Mistakes
  • Wrong Medical Record Number
  • Wrong ICD-9-CM codes
  • Duplicate claims
  • Wrong date of service
  • Wrong rates charged
  • Wrong number of dates in hospital
  • No match between the ICD-9-CM code and CPT code
  • Billing for more Operating room time than used
  • Billed for unjustified procedures or tests not done.
  • Miscoding the “DRG”
  • Unnecessary staffing for the procedure
  • Bill amount totaling mistake
  • Unbundling charges that should be packaged together
  • Treatment provided that was not validated
  • Service was not a medical necessity
What percentage of students get job as Medical Billers or Medical Coders after graduating?
Statistics show that around 70-80% of students land up with jobs. The remaining 20-30% do end up taking some different job or altogether leave it for some better reasons.
What are the different jobs and designations that Medical Coders / Billers can get?
Depending on work specialization, Medical Billers and Coders may work as:
  • Medical Billing Specialist
  • Electronic Claims Processor
  • Billing Coordinator
  • Coding Specialist
  • Health Information technician
  • Claims Analyst
  • Reimbursement Specialist
  • Claims Processor
Medical Billing and Coding Certification
The three important certifications exams that can be obtained to get a certification as Medical and Billing Specialist are:
  • American Medical Billing Association (AMBA) CMRS Exam to become a Certified Medical Reimbursement Specialist (CMRS).
  • American Academy of Professional Coder's (AAPC) Exam to become a Certified Professional Coder (CPC )
  • American Health Information Management Association's (CCS or CCS-P) board exam.
One can chose to give any one of these certification exams.
What is the Average Salary & Job Outlook of Medical Billing Specialists?
Medical Billing & Coding wages range from $20,000 to $42,000. Small business owners can go up to $100,000 annually. Salary also depends on:
  • The number of years you have worked in medical coding and billing
  • Geographical location.
  • The size of the medical organization.
  • Educational level
Medical Coding
The American Academy of Professional Coders reports that Coders earn in the range of $36,085 to $40,000, depending on the part of the country in which they work. Job outlook is good. It is one of the fastest growing professions that will see no recession.
How long does it take to finish the medical billing program?
The length of the medical billing program usually varies from 4 months to a year. However, most of students complete the course within 4 to 6 months.

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