Concern on Math or Accounting Ability Required for Medical Billing

by Selamawit
(San Bernardino, California)

Hi Gina,

This is a very informative webpage I have ever come across on Medical Billing & Coding. Thanks for your great work.

I am interested to take this course as it takes a short time (compared to other growing fields) to get a certification as I need to start working immediately (expecting to be hired of course :)). I live in San Bernardino, Ca. If I take this course I intend to go to campus, I do not wish to take an online course. My question is -

I am not good with numbers and with accounting. Do you think for an average person in understanding number related courses, I can do it? Or in short, what should I expect in relation to this?

Thanks a lot,

Hi Selam

Response:

Selam,

I think at least an average understanding of math is necessary to be a good medical biller. A medical billing specialist uses math to determine and balance differences between charges, insurance write-offs, deductibles, and co-insurance. It’s mostly just addition and subtraction and understanding the types of charges, payments, etc. It’s also important in understanding and apply payments from primary and secondary insurance.

For example a provider may charge $200 for a procedure, the insurance company may only allow $150 per their contract with the provider and only pay $135 of that $150. The patient would be responsible for the difference which is $15 in addition to the co-pay. The patient may have a deductible which makes it a little more complicated - but that gives you a simple idea of the typical math we perform. The insurance company EOB (Explanation of Benefits) will typically show what these amount are but it’s not always obvious or easy to read.



Billers should also have good software skills for navigating the medical claim software and entering data into the software. We typically enter a lot of charges, diagnosis or treatment codes and modifiers, fee schedules, account notes, names, addresses, payments, and stuff like that. You also may need to know how to apply late fees to patient past due balances depending on the policies of the provider - like adding a late fee by multiplying the past due balance by the penalty. For example if there is a 10% penalty for being over 60 days late and the patient has a balance of $150, the late fee would be 10% of $150 = $15.

Having a good math aptitude helps to understand the types of reports we occasionally have to generate, read, and interpret - they have lots of numbers. Like insurance or patient aging reports. They usually have balances listed for 30, 60, 90,120+ days past due and can be created in just about any format - like by insurance company and patient. These reports give an indication of how effective the billing is. If there’s a high percentage claims not paid, that reflects badly on the medical biller.

Thanks for contributing a great question to the site. Hope we’ve given you some info to help understand the role of math in the medical billing process.

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Oct 28, 2014
I have a question
by: Anonymous

Hi Gina,

I am 17 years old and I am currently a senior in high school. I have a passion for the medical field and one of my siblings is a medical biller. She has told me a lot about it and I would love to become one as well. I am good at math but terrible at Pre-Cal.

Is Calculus a required math in medical billing?

Response:

Great question!

Medical billers and coders typically don't get into any advanced math like calculus or algebra. We do frequently use more basic math like addition and subtraction to determine co-insurance and deductibles - things like that. So it does help to be proficient in basic math.

Many times the practice management software will do a lot of the math in determining insurance or patient balances.

Thanks for your question!

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