What's involved with processing medical claims from home? Learn from a medical billing home business owner the specifics of medical claims processing at home, how it works, and what you need to process claims.
In this day and age everybody wants the flexibility to be able to work from home. One of the more popular is medical billing jobs from home which involves medical claims processing at home. However there's more to it than just entering data on a computer.
How does it work
Processing medical claims from home involves entering patient and provider information along with the appropriate ICD-9 (or ICD-10) diagnosis and CPT treatment medical billing codes. The patient information is insurance ID, address, phone, responsible party, age, etc. Provider information is NPI number, name, address, practice name, etc. The diagnosis and treatment codes are usually obtained from the superbill. However those performing medical coding from home will take the doctors notes and assign the diagnosis and treatment codes.
The key is the information must be provided in a secure manner to comply with HIPAA security and privacy standards. Probably the best way is either via scanned document stored on a secure server or transmitted via secure email. Faxing patient information can be dangerous because if the information can be mistakenly sent to the wrong fax number. Many fax machines have pre-programmed numbers and it's easy when things are busy to fax to press the wrong button. I've been on the receiving end of a few of these misguided faxes. There's also the concern that you never know how secure the destination fax is. It could be open to anyone walking by and you don't want patient info exposed like this.
There's also the option of physically picking up the info to be processed at the providers office. Some billing services or those who work for a practice and are processing medical claims from home will arrange to pick up on a pre-determined schedule - like once a week or a couple times a week. But most busy practices need claims processed promptly to get paid. The caution here is that the information be protected on its route and not left unprotected in the couriers car.
Insurance claims can be processed one of two ways; via paper or electronically. The link above gives a more detailed description of claim processing, including a flowchart showing the claim process.
Of course this is done using a medical claims billing software of which many varieties are available. Those processing medical claims from home need to have this software on their PC or access to it via internet. If you are working from home for a doctor's office, you would require remote access to the practice server where the medical claim billing software resides. This typically done via Windows Remote Desktop or some other secure means via the internet.
For those operating their own healthcare billing service, they would typically use their own billing claim medical software running on a local computer or server. However online medical billing software is becoming more popular that allows access using a web browser. This is nice because it doesn't require any special software to be installed and you don't have to worry about backing up data or secure servers, etc.
Paper claims simply require printing the claims on the pink CMS-1500 forms and mailing to the different insurance companies. Sending claims electronically involves creating a file (or batch file) and transmitting or uploading the file to the clearinghouse or insurance company. This is typically done through their website. Once claims are submitted the clearinghouse and/or insurance carrier will generate a report indicating if the claims were accepted. If they were rejected the report should give the reason why it was rejected so the claim can be corrected and resubmitted.
Most rejections on the front end (when initially submitted) are a result of errors or typos in dates, insurance IDs, names, coverage dates, errors in codes, etc.
Usually the person processing medical claims is also responsible for other tasks related to billing. Medical claims processing from home can also involve following up on denied claims, correcting and re-submitting these claims, appealing denied claims, posting insurance and patient payments, answering patient questions regarding their bill, etc. Here's more info on all the medical billing specialists responsibilities. The biller is usually expected to "own" the claim from creation to payment and everything in between necessary to get it paid.
What does it pay
If you work for a doctor's office or billing service a typical medical billing salary ranges from $10 an hour to over $15 an hour. Depends on experience and who you work for. Most people processing medical claims from home are more experienced and will be on the higher end of the range - and can be well over $15 an hour. I've heard of some who are really valuable to a practice making closer to $20 an hour. If you operate a medical billing home business, the pay can be higher depending on the practice being service and the negotiated fees.
What do you need
Since processing medical claims from home can be done via computer, all you really need is a computer and high speed internet connection. Most health insurance claim software runs on Windows computers or servers so a Windows PC is best here. I'm sure there are some Mac based systems but I haven't seen any and wouldn't really want the complexity of trying to work out Mac verses Windows issues.
It's also important to have an office or workspace that can be secured when not in use. This is to protect any provider and patient data from unauthorized eyes.
Probably most important is to have the opportunity for processing medical claims from home. This is only possible if you work for a practice, hospital, or physicians billing service that allows you to work from home - or if you have your own medical billing home business.
Typically working from home for an employer requires a level of trust that comes with a lot of experience in the field and working for this particular employer. You may see advertisements for home medical billing jobs or medical claims processing at home but they are usually thinly disguised attempts to make money for some overpriced business opportunity. So be wary of these ads - if it sounds too good to be true it probably is.
If you have worked for a practice as medical billing specialist and have a good relationship with the doctor or office manager, this would be a good opportunity to approach them about medical claims processing at home.
Operating a medical billing business requires training and knowledge to be successful. The financial success of a doctors practice and those they employ is dependent on a good medical billing specialist. And they aren't going to turn this responsibility over to just anyone they don't feel will improve their present situation. Being a successful medical billing business owner requires training in the field, the ability to produce results for your client, and convincing a doctor to entrust you with the billing.
In summary processing medical claims from home is viable. It takes the right situation or opportunity, training, and a good knowledge of medical billing. From my experience it requires self motivation and the ability to separate home from work, but it sure beats going into an office every day.
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