Questions about medical billing
Medical
Billing - Is it the business for you?
You've probably seen the ads in your local
newspaper stating how easy it is for someone to do Medical
Billing from home. "No experience necessary, will train."
Unfortunately 99.9% of those ads are false. Medical Billing
is a career choice, which requires education and/or experience.
Owning a Medical Billing service requires general business
management skills. It's not as simple as buying software and
a list of doctors "needing" your services.
What
is Medical Billing?
Typically, billing involves collecting needed
data for completion of insurance claims forms (patient information,
copies of insurance cards, and a copy of the superbill or
encounter form, the form on which the doctor documents what
kind of care was provided and the code to use for procedures
performed and the diagnosis) and entering it into a practice
management/patient accounting software program. Lytec,
Santiago,
Medisoft,
and Altapoint
are the names of a few reputable less expensive software vendors.
By less expensive I mean less than $3000. See the "How
to Choose Software" section for more information. Sometimes
the Biller may also be required to verify patient benefits
prior to the doctor providing care. The Biller must know the
claim submission guidelines before submitting to an insurance
carrier. Most claims will be submitted electronically but
there are still claims that must be sent on paper. Therefore
a Biller must know how to fill out an HCFA-1450 (UB-92) or
HCFA-1500, the two most common claim forms.
After the claim is sent the Biller must
know how to perform patient and third party payer follow-up.
Effective time and paperwork management skills are mandatory.
If a claim is denied, the Biller must know how to review the
EOB (explanation of benefits), checking for errors and resubmission
possibilities. Knowledge of the appeals process is also very
helpful to increasing the client's cash flow. If the claim
is accepted the Biller will receive a copy of the EOB and
post the payment received from the insurance carrier to the
patients account. If the patient has a balance it is the responsibility
of the Biller to determine if it is to be written off or balance
billed to the patient. If the patient is to be charged the
Biller must prepare an invoice to send to the patient. Generally,
it is the Biller's job to follow-up on unpaid balances from
patients (or insurance carriers for that matter), sometimes
referred to as "soft collections." There are guidelines
that have to be followed when trying to collect late monies
from patients, as you can't act as a collection agency in
most states.
Weekly, bi-weekly, and monthly A/R (accounts
receivables) reports are generated and turned into the client
so he or she will know where the money is going, if he or
she is losing money on certain insurance contracts, etc. Some
additional services billing services provide are carrier contract
reviews, patient recall cards, and appointment reminders.
There are some billing services that offer claims processing
only but this is not efficient for most practices. The doctor
doesn't receive the follow-up his claims need and demand.
A lot can slip through the "cracks" with a claims
only type of contract. Another new way some Billing services
are obtaining clients is by offering a "Transitional
Contract," which allows the doctor to outsource to a
service for say 60 days and if he or she is not happy then
they can break the agreement without any questions asked.
Fraud and abuse are BIG issues for those
in the Medical Billing industry. Anyone considering starting
their own service MUST read up on Compliance issues, rules
and regulations. A great place to start is the OIG
(Office of the Inspector General). "The
Reading Room" contains invaluable information on third
party billing compliance and more. The Health Care Financing
Administration is a great place to read and learn about the
industry, especially Medicare and Medicaid. The HCFA also
provides FREE,
online Medicare training courses.
Can
I make a living doing this?
Yes, you can. There is also no set salary
for an outsourced Medical Billing service. I've heard some
services make $25,000 a year and some that make over $100,000
a year. It all depends on the number of clients, how many
years experience and exposure, what type of specialty is being
billed, etc. You must possess the knowledge and skills it
takes to make a business successful. You must know how to
market your services. You won't be able to quit your job today
but with determination and dedication you can make this a
profitable business. As with any business, it will take time
to sign your first client and establish a solid clientele.
There is no standard time frame, some people have signed their
first client within a week of their marketing campaign for
others it may take up to a year. Be patient and remember to
refine your marketing skills. Getting your business name out
there is the only way people will know of your services.
Do
I need experience?
Yes, without a doubt. Education and/or experience
are absolutely essential to success in Medical Billing. There
have been so many inexperienced Billers try to sign clients
who have no idea what they're doing or how to do it. A lot
of these people have been sold these ideas from fraudulent
software vendors who tell them they need no previous experience
or training. A good number of doctors and practices have been
seriously screwed up due to the errors of inexperienced, uneducated
people who thought they could just sign a client and data
entry claims. Whether it is through previous work experience
or completing educational classes, please obtain the know-how
BEFORE trying to market yourself. If you're unable to do so
outside of your home, the availability of online courses is
rapidly growing. Courses should include, but aren't limited
to, medical terminology, CPT coding, ICD coding, instructions
on completing HCFA forms, managed care, the different types
of insurance, insurance regulations and rules, anatomy and
physiology, compliance issues and practice exercises and/or
tests.
Beware of associations or companies promising
"certification" after course completion. "After
you've completed this course you'll be awarded the title of
Certified Medical Billing Specialist." That's fine and
dandy but it will only mean something to you and the certifying
agency. Currently there is no mandatory billing certification
nor any nationally recognized certifications. If you earn
a certification it'll only be known and recognized by the
certifying association. However, it will look good on your
resume or CV that you've put in the extra effort to attend
or participate in an educational program. One association
who has had good online course reviews is the Medical
Association of Billers. MAB has a forum
too. Forums are awesome outlets for networking, support, questions,
and marketing tips. A good association to join is AMBA (American
Medical Billers Association), which offers its
members great benefits, education and training. My personal
favorite and "home" is Medical
Billing on the Internet forum. This forum has
a great group of visitors ranging from people researching
billing to those who've been in the Industry for 25 years.
You must know how to own and operate your
own business. You will have no boss and no one to tell you
what to do. You will need to know how to manage your time,
money and various other tasks. There are plenty of resources
available to new business owners and people thinking of starting
their own businesses. A great new website I located is My
Own Business, which is a Non-Profit organization
that offers a free online course on starting your own business.
First, start with what kind of education and/or experience
you have or don't have. Next, obtain as much experience as
you can by working in a doctor's office, volunteering your
time at a clinic or doctor's office in exchange for training,
attend local college courses in the classroom or online, and/or
find other reputable training courses online. I should note
here that as in most Industries you would be learning continuously,
sometimes day-to-day. After you've gotten a solid knowledge
base you need to put together a business plan. You will have
to stay up-to-date on all the latest Insurance carrier news
and Federal/State rules and regulations.
If you have your business plan completed
the next step is to create your marketing plan. Then choose
your software. Finally, start to market your business locally
or nationwide. This is just a brief overview of the steps
to get started. Read and research as much as you possibly
can on the topics of medical billing and owning a small, home
based business.
A few more great websites for medical billing
information and resources (that I haven't previously mentioned)
are:
K&L's
One Stop Resource for Medical Billers
The
Coding and Reimbursement Network
A good article to read is The
Truth About Medical Billing From Your Home by
Willa Davis, AAMB (American
Association for Medical Billers).
How
do I choose a reputable course and/or software program?
The best way to find out if an at-home correspondence
or online course is reputable is to ask other people. Get
on forums, discussion groups and e-mail/listserv groups to
ask if other people have heard of a particular "school"
or actually attended themselves. Try to not to take everything
people say as set in stone. Take it with a grain of salt and
keep investigating for yourself. You could request a report
on them from the Better Business Bureau. If you're still not
sure, request a course outline from the "school"
and review it yourself. Does it seem worth the price? How
many lessons are included? Can you get a refund if you're
dissatisfied with the course once you view it? What topics
are covered? Which aren't? Ask for more feedback from the
forums or groups you've joined. In the end it's all up to
you and what you feel in your gut. Majority of the at-home
correspondence and online courses are very basic, which means
they're a great starting point but definitely not to be considered
a solid foundation for you business. In other words, you can't
go out and sign a client with only an at-home course under
your belt. You'll need to combine them with either further
educational courses or better yet on the job experience.
Choosing a software program is a very personal
decision. Only you know where you want your business to go,
how many clients you'll have or do have, what specialties,
how much training or technical support you'll need, what kind
of reporting capabilities you'll need or want, and which types
of software programs you understand and operate without a
lot of struggle. The best way to decide is to request a demo
of the actual program. All four of the software vendors I
listed in a previous paragraph provide demos free of charge
by snail mail or e-mail. Test them out, "play" with
them, input pretend physicians, patients and insurance carriers,
print out reports, etc. How much is the software? Does it
seem worth the price? Is there a payment plan? Are there different
versions of the program? Are you looking at the appropriate
version for your business size and/or needs? Will you need
to buy software updates? How much do those cost? How often
are they released? Next, look at the kind of training offered
and whether you'll need more or less. How much extra is the
training? If included what exactly does it entail? Is it a
manual, CD-ROM or videotape? Can you get a refund if you're
not satisfied? Then investigate their technical support. How
much does it cost? How much time (phone calls, e-mail, etc)
do you receive for that price? How fast is their response
time? Ask around about specific software companies BEFORE
you buy anything. Again, join in on a forum or check out old
messages, which almost always have an answer to the question
you need to ask. Ask for feedback from other users. A must
visit forum is Medical
Billing Scam Watch. Scam Watch lists all the
companies that have been reported as fraudulent and/or had
a lot of complaints about their business practices. Plus,
there's a section for getting started. Here's a good discussion
on Questions
You Should Ask a Software Company. This article
is not the gospel.
This is simply a starting point for your
ongoing research and education about Medical Billing. If you
have more questions, which I'm sure you do, please visit one
of the forums I've listed. You'll be amazed at how helpful
complete strangers can be with your questions. Also, do not
forget to read as many of the old messages as you can before
posting your questions. You'd be amazed at the amount of information
available in the older messages. If you take anything with
you from this article I hope it is this--knowledge is the
key to your success. If you gain the appropriate education
and experience you can be successful in owning a home-based
Medical Billing service.
© 2000 Leah Saylor-Abney
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