Insights and Tips into Medical Billing

Monday, September 26, 2005

Medical Billers Duties

Outsourcing insurance claims processing drastically reduces a physician's office overhead and improves their reimbursement turnaround from the insurance carriers, which allows them to focus their efforts on their practice and patients.

The trend today is outsourcing. Outsourcing will continue to grow into the coming decades as the most effective and efficient way to successfully operate a medical practice. More and more healthcare providers are coming to the realization that they too can outsource insurance claims processing to a billing service more effectively than doing it themselves and at a mere fraction of the cost.

"Outsource whenever possible . . . why do something yourself if it can be done better and cheaper on the outside? Look at the numbers and see how you can save money while keeping tight reins on essential operations." Entrepreneur Magazine - March 2004

Medical billing encompasses, for the most part, all billing and accounts receivable management functions of a given healthcare practice. The major objective is accurately submitting claims and patient statements to receive the correct reimbursement for services rendered, in the shortest amount of time. To achieve this goal, the medical billing service will provide some or all of the following:

Provide a suitable mode of patient information retrieval. This can be done several ways. Direct link to the provider's office, fax to a secure line, mailed to the medical biller or encrypted over the internet. Set up patient information on their billing system. Enter charges for each office visit and procedure. If electronically filing claims - transmit electronic claims and receive audit reports.

Print paper claims for any carrier unable to accept claims electronically. Post payments received from insurance carriers and patients. Print and mail patient statements. If applicable respond to patient calls regarding their account. Follow up on any unpaid claims. Patient and insurance aging reports that are produced by most computer programs are valuable tools when reconciling accounts.When applicable, print month-end or quarterly production reports: Practice analysis, aging accounts receivable and referral reports for providers.

Ethical Responsibilities for medical billers are important because medical billers are privy to personal and financial information of both the medical practice and their patients. It's important the biller act in an ethical and legal manner. HIPAA has mandated the standards required of all medical personal with regards to patient confidentiality. It is imperative for all medical practices to adhere to these standards. Click here for the Office of the Inspector General's guidelines on compliance requirements for medical billing services. A qualified medical billing service will present the provider with a confidentiality agreement to meet the HIPAA compliance regiments.

Legal responsibilities for medical billers include all areas of billing. It is illegal to report incorrect information to government-funded programs, such as Medicare, Medicaid, and CHAMPUS. It is the medical billers responsibility not to submit any claim with improper coding or information, and to inform the provider of illegal coding practices. It is imperative the medical billing service monitor all billing with regard to incorrect coding that may be viewed as fraudulent billing. Medical providers can be fined up to $10,000 for each service deemed frequently billed. Medicare deems not billing a patient copayment as fraudulent and an abuse the Medicare system. It is the medical biller's duty to stay current with government regulations and keep the provider in good standing.

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Blogger Sun Rahman said...

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2:17 AM


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