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How hard is medical billing

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.
  • Understanding and staying abreast of the Affordable Care Act and how it relates to the medical billing 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.

    Category: Bank

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