Medical billing and coding is a procedure or a linkup between health care provider and insurance companies. Typically as the name suggests, it consists of two part medical billing and medical coding. Medical billing starts as soon as person or a patient visits his health care provider, where his medical record is being created. The record not only contains his personal information but the all the information regarding his diagnosis, illness, medication and all the treatment procedure. All those procedures and records are necessary for both patients and insurance companies as former can reimburse all the expenses and latter can validate that whether they cover the specified scenario or not. It’s not a matter of a day, rather if amount is huge it will take from several weeks to months to resolve. As insurance companies have their own sets of rules to follow, they validate everything before actually issuing the money to the health provider. Though in most cases it’s the insurance companies that get benefits from it as they simply state that they don’t cover it.
Insurance companies have had their own staff of medical claim examiners or medical claim adjusters, who thoroughly go through the claims and evaluate the validity of payments for the patients. It is not obligatory for the insurance companies that they had to pay all the expenses claimed by the patient unless they are bound to which is quite rare in most cases. Mostly insurance companies settled for covering 30 – 50 % of total expenses claimed by the individuals, as these companies are accompanied by a full team of legal advisors and other experts in the field.
Diagnosis is a complex procedure as it’s not necessary that you are diagnosed on your very first visit. So some time it takes time as well, and during that you have to go through different medical examinations. All medical examinations and tests are not covered by these insurance companies, so later on you cannot claim for these tests and medical examinations. When diagnosis has been completed and diagnosis codes have been determined, the billing professional transmits the claim to the insurance company for reimbursements. The claim file is sent to the insurance company directly or through clearinghouse sometimes. Claims which fail to get accepted are sent back to provider with a notice. After receiving rejected claims, professionals are required to make the corrections in the information and submit the claim again. The whole cycle just keep ticking unless all the issues are addressed properly and resolved accordingly. As mentioned earlier the whole process can take much more time than anticipated earlier, as the draft or contract which is signed by you earlier is crafted by a team of experts in their respective fields including Physicians, surgeons and legal experts. It’s very important for both parties to clear things in first place and get the full understanding of what you are doing.
In case you are interested in starting a medical billing from home, you should learn about a number of different things that are most important. You would have probably read that starting a medical billing business from within your home is an easy job but care needs to be taken in this process along with a nice amount of research before you finally decide something. Different institutions that are providing training programs usually portray the picture that making a lot of money is possible with medical billing business or they would persuade you to undergo the courses provided by them with the main goal of establishing your own business at the end of that program.
STEP 1- Check Competition in Your Area
Prior to starting a business based within a home, you should perform plenty of research with knowledge of the things that you require to set up a new business. This should not only contain information from local authorities on the documents and licenses you need to start the business but also details about the type of business that you are about to start. This means that you should carefully collect details about medical billing before you start a home based business. The first thing that you need to know is to check out the competition that you will be facing and knowing about the number of other businesses operating in your area. If the community is small, you will be able to find less competition which allows for better options to be available to you.
STEP 2 – Learn about Local Health Centers Medical Billing Organizations
You should learn about the way your local health centers are doing the medical billing and coding through their own staff or if they are outsourcing that task. Learn about the companies to which this work is being outsourced and in case it is not being sent to other companies try to know if they would think about outsourcing their work. Sometimes the work is being outsourced to specialized medical billing and coding organizations that make it difficult for a home-based business to compete with specialized companies.
STEP 3 – Find School for Medical Billing Training
It is also important that you undergo training programs from different schools or colleges that are locally or internationally recognized. The programs and courses are also sometimes offered on the internet which you have to be careful about. The accreditation of the institutions that you will be joining should also be known. You should look for a number of things when you decide to start medical billing from home. It is quite important that you select an institution which is recognized nationally. It is important that you take the perfect courses that you would be utilizing in your future life instead of learning something that isn’t required at all.
STEP 4 – Analyze Cost of Starting Medical Billing Work At Home
You should make sure that you don’t start your home based medical billing and coding career until you have not completed the research about the profession and the other businesses that you would be possibly dealing with. It is also important to find out the costs that would be required for the software that you would need and you should only start the business if it is really profitable.
Your health is the most important aspect of your life, without good health every luxury in life seems colorless and trivial. The people who take care of your internal health care are doctors, due to the importance of health in life this service is not a cheap one. To fight an ailment drains your physical energy and your financial resources, and hence health insurance is one of the most important security that you need to have. Insurance helps to cover your medical bills and helps you sail smoothly through tough times, but this procedure is not as simple as it looks, there is extensive paper work required from the medical center etc. A medical billing and coding hence is an integral part of the medical management team, it usually happens that when we hear the word hospital we automatically assume doctors, nurses and patients and do not think about the force behind the organization, those people who quietly do their work and run the hospital, the management. Yes the medical billing or coding is an important part of the overall organization and might not get the limelight but his part in the organization is bigger and more important then you may think.
The medical billing and coding professionals are those who assigns codes to different medical tests of patients and communicates these codes to the insurance companies to simplify the process for both the hospital and the insurance company. Their main responsibility is interoperating the codes and working with the insurance companies, but many times the medical billing also needs to interact with the patients, explaining the procedure to them or being a communicator from the insurance company. They are also required to keep the records of bills of patients and preparing invoices, these tasks may seem trivial but are very important if you look at the bigger picture, since it is these records that are further used by the financial department.
Five reasons to choose medical billing and coding profession are as follows -
• Educational requirements: The educational requirements for this job are far less than those for a doctor. Even though the certification is not necessary in this field but it is highly recommended for getting good job and salary.
• Pay: Medical billers get very handsome pay, because of their large demand, since it is not a profession that you would immediately choose the pay provides a good incentive to peruse this career. A medical biller gets 35000-45000$ per year. Check More about Medical Billing and Coding Salary.
• High demand: The demand for billers in increasing, and more and more billers are needed in hospitals as well as private clinics, making this a very attractive field with numerous opportunities.
• Technological advances: The availability of numerous software and sophisticated technology has made the paper work or recording etc a lot less painful. So a medical biller of today does half the work, the other half is taken over by the machinery made to help humans.
• Flexibility: This is one of the fields that allow you to work for more than one organization and even from home. This career is very flexible and allows you to move around anyway you like.