by Tonya
(KY)
I am doing a paper on medical billers for my medical insurance class. I am wondering a few things, like what you like and dislike of a biller. Do you have paper or electronic claims? If computerized what system do you use? What advice do you have for someone trying to learn about medical billing?
Tonya,
First the dislikes – here’s my least favorite things a medical billing specialist has to deal with:
- Dealing with Medicare – as with any government agency they can be very frustrating.
- Unpaid or rejected claims – they can require a lot of time and investigation to resolve.
- Cleaning up a billing mess left from previous billing service or biller.
- Angry or difficult patients with account problems or billing issues. They blame the biller or provider for problems with their insurer.
- Difficult or ungrateful doctors that don’t appreciate the effort and time put into making sure they get paid – and don’t understand the sometimes significant effort it takes to resolve billing problems.
- The nature of the work can sometimes be overwhelming. I sometimes feel like I can never catch up – but there is a certain job security in that.
And the likes:
- Being an integral part of the reimbursement process. The work that a biller does is so important to the financial health of the practice.
- Being able to work with some great providers who go above and beyond their obligation to serve patients – especially those in need.
- I enjoy working with numbers and getting accounts correctly posted and balanced. It can sometimes be similar to accounting.
- Solving problems with the billing and coding for a provider and seeing their reimbursement significantly improve due to my efforts.
Just about all of our claims are sent electronically. We submit them to a Clearinghouse in batches usually on a daily basis. The clearinghouse takes the claims we send and distributes to the individual insurance companies in a format that’s acceptable to them. For insurance carriers the clearinghouse can’t send electronically, they will send a paper claim.
The clearinghouse saves us a lot of time and effort. We also send many secondary claims by paper once the primary claim is paid and posted. We just print it out on the standard CMS-1500 form.
We use a Microsoft Windows server based system running either AltaPoint or Lytec medical claim software. They are both very capable systems.
As far as advice for those wanting to become a medical billing specialist I would recommend working with or for someone that already has a lot of billing (and/or coding) experience. I started working for a billing service and the owner was very knowledgeable on billing. I learned a lot that I would never have learned in a classroom setting.
Thanks!
Gina