Which Medical Billing Specialty to Bill For?

by Anonymous

There are so many directions in medical billing a person can go to choose as to their first client to start off in billing for them. You suggested to possibly start off with a small practice.


But when you got your 1st client were you familiar with the specialty codes? I want to focus on the billing aspect of course but you have to be familiar with the codes to A DEGREE, don't you? Was choosing a specialty a challenge for you? How did you go about making this decision?

Response:

The specialties I concentrated on were the ones I had some experience with working for a billing service: Family practice and mental health billing. But I really didn’t limit myself to just those practices when trying to find that first client. I really solicited every specialty - even if I didn’t have a lot of experience in it.

Sometimes there are nuances with the particular specialty in addition to the codes and you may need to invest extra time before meeting with the client to get a feel for their specialty. For example with mental health there are usually insurance limitations such as authorizations from the insurance provider and limitations on the number of visits - so those things have to be tracked in addition to filing claims. But I really loved billing mental health because a lot of the claims were very similar and didn’t have a lot of issues and rejections.

You really want to watch out for some of the smaller specialty providers who don’t have good coding practices or resources. Or don’t have anyone who knows how to code their specialty correctly. What I notice is that they can do a lousy job coding - which limits their income - and expect the billing service to figure it out. Or worse blame the billing service because they don’t understand how to code their own procedures - which is their responsibility.

Family practice is usually less complicated than specialties but there can be a wider variety of codes and modifiers depending on the practice. There’s usually also a more claims to file than a specialty since they can see 30 or more patients a day. I also billed for chiropractic but since there’s more private pay it’s more difficult make much on filing insurance claims.

One of the reasons I recommended a small practice is that they usually aren't as busy - especially if they are just getting started. They are usually trying to build their clientele and don’t have as many claims to be filed. Taking on the billing for a busy practice that sees 30+ patients a day can be overwhelming if you haven’t done it before. And there’s a lot of pressure to get claims filed and paid immediately. There’s also a lot of work on rejected or unpaid claims.

You may also want to start by offering to work on unpaid claims - or insurance aging. That way you can learn the specialty and prove yourself without the immediate pressure of trying to get up to speed and get claims paid like you would if you just assumed all the billing responsibilities.

I think the important things is for a biller to be on top of the claim filing - making sure all the necessary info is entered and correct and making sure the claim is accepted by the payer. After that it’s aggressively addressing unpaid or rejected claims and getting them resubmitted. And also make sure patients are billed as soon as insurance is applied and promptly posting insurance payments.

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