Saturday, August 7, 2010

What is a Medical Billing Specialist?

Whether you are a person who is thinking about becoming a medical billing specialist or a company looking for a medical billing specialist, then this article is for you. There are several things that you should be aware of in the medical billing work industry and I will walk you through them so that you will have the background information that you need to help you make a decision that will best suit your needs. We will first take a look at what it takes to become a medical billing specialist, and then we will also explore the alternatives to hiring a medical billing specialist.

What is a Medical Billing Specialist?

A medical billing specialist is someone who works with a medical office and is in charge of the company's medical billing. If you desire to be a medical billing specialist and find medical billing work then accuracy and attention to detail is a must as you will most likely be in charge of claims processing, charge entry, and billing and collections. However, most medical offices will hire someone to do more than just be in charge of medical collections. They will want someone to be more of a medical assistant as well. Medical billing work includes things like:



o Accounts payable, payroll and banking tasks

o Prepare and maintain patient charts

o Schedule appointments

o Receive and make phone calls

o Perform insurance verification, pre-authorize and referral duties



How do I become a Medical Billing Specialist?

Most businesses will require you to either have several years of experience working as a medical assistant or some kind of advanced certification as a medical assistant. There are several programs out there to help train and educate you to become a medical billing specialist. By doing a Google search for "medical billing specialist" you should be presented with a lot of options to help guide you to becoming a certified medical billing specialist. There are programs that you can complete online and at your own pace. Others require you to attend some classes for a couple of semesters to find medical billing work. In my search I found many of the programs to cost around $1000but some were as much as $6500.

Is it worth it to become a medical billing specialist?

The medical industry is experiencing a tremendous demand for individuals knowledgeable in medical office operations. Medical billing specialists are one of the fastest growing professions and are currently a very high demand job. According to the American Medical Association, there are over 1.2 million Medical Specialists in the United States. If you are interested in this kind of profession, it would be to your advantage to learn more about it.

What about outsourcing?

Because of the time and meticulous accuracy that medical billing requires, there are some companies that only specialize in being a medical billing specialist. Medical offices outsource all of their medical billing practices out to these companies rather than hiring an in-house specialist to manage their medical billing needs.

Is there software that can do everything a Medical Billing Specialist can do?

There is yet another solution to managing your medical billing needs. Companies such as AdvancedMD provide a software solution to be your medical billing specialist. An advantage for a medical office to go this route might be that it will be cheaper in the long run to have software to manage all of their billing needs. Also the electronic medical billing specialist will be less prone to errors unless they are due to a human entry error.

So, What is a Medical Billing Specialist? As you can see there are many answers to this question, and many solutions to help you to better manage your medical office. There are advantages in every category; it just depends on what will be the best fit your office. If you are thinking about becoming a medical billing specialist, I feel that it is worth looking into as it is a very high demand job. However, you should be aware that with alternatives out there, like outsourcing and medical billing software, you might have a little competition.

Thursday, July 22, 2010

Medical Billing Work From Home

Not to long ago several entrepreneurial and financial magazines stated that medical billing work from home was one of the top ten home based businesses for the new millennium. While the reports were correct it took almost 4 years before the information sunk into the heads of those that were desperately looking for ways to leave the nine-to-five rat race and work from home.

What the masses didn't know was that during those four years several so called medical billing work from home support companies were in full swing selling their wares and services to the undereducated looking to get into this lucrative field. The majority of the companies were well thought out scams and because most people had no idea of what was needed to do medical billing from home made those companies rich.

Today, while the medical billing work from home industry is still a growing field there are several companies that spend a lot of money advertising in different venues to take further advantage of the unsuspecting public. These medical billing from home companies know that the majority of folks will not do any research before getting involved, they make it easy for you to contact them, they have very convincing sales reps waiting to con you out of your money and for a mere $400 they tell you that they will supply you with everything you'll need to make $40-$60K per year from the comfort of your home.

Friends, let me tell you right now that there are no medical billing work from home companies out there that can afford to supply all of that for $400 and stay in business! Common sense would alert most people that this is a scam, but because most people are so blinded by the money making potential they don't listen to that little person inside that usually yells "It's Too Good To Be True".

How Do You Go About Avoiding The Scamsters In The Medical Billing From Home Industry?

1. Don't answer those ads that you see in your favorite local shopper magazines (Globe, Sun, Examiner, Thrifty Nickel, PennySavers, etc.) or in some of the major daily newspapers. They usually go something like this:

"You Can Earn $50,000+ Processing Medical Claims From Home. No experience necessary! Call 1-800-***-**** for information."

2. This one is usually seen on the Internet but lately it can be found in any number of widely sold financial/entrepreneurial magazines. These ads are placed by medical billing from home opportunity vendors that want you to purchase training, software, marketing materials, and lists of doctors as a package deal for $4000-$9000. Now there are a handful of well known medical billing from home opportunity vendors in the nation, but if you aren't sure who they are you must research the company in depth before you contact them, but they do exist.

3. Watch out for what is called medical billing work from home resellers of well known/branded medical billing software programs that are the most basic in design and won't be able to support your business for years to come. So you in turn will need to call them back and spend more money with them to upgrade the software (so you get taken twice). You can find these cheap pieces of software all over the net, on Ebay and from people's personal websites (most of whom don't know anything about doing medical billing as a business).

4. Look out for medical billing work from home software companies that also claim to be their own clearinghouse companies. They will claim to give you discounted clearinghouse services because you initially bought software from them, but you will have to agree to submit your claims exclusively through them. Again you are paying twice, except this kind of service is an extended and drawn out milking of your wallet and the biggest problem is what happens if the company goes out of business? That's right you're stuck big-time and you'll have to spend a lot of money to get things back on the right track. This is the same as putting all of your eggs in the same basket that we've been hearing about since we were young.

5. You should always research a medical billing work from home company before you do business with them unless you are getting a referral from a very trusted friend. The best way to start your research is by going to the BBB and doing a search for the medical billing from home company you are looking to do business with. You can learn a lot about the company including if the company has any open complaints against them from their customers. You will also see if they have a favorable rating, which goes toward their credibility.

6. The next thing that you should do is visit and partake in the discussions at any one of the several medical billing work from home forums. These forums will become the basis of your support network and will give you the opportunity to ask questions of established home-based medical billing business owners. The other benefit is that you will also meet other new medical billers that are on the same level of getting their business started as you are, so you know that you're not the only one who has fears about getting started. Once you dispel the fears then you can focus on the topic at hand and proceed with full confidence in your decisions.

Many people that try and start their own medical billing from home business usually fail to do so because they have skipped one or all of the aforementioned. The sad part is that they cry foul and say that the medical billing work from home industry is a scam instead of owning up to their own faults.

The medical billing from home industry is a great business to start but it's not for everybody so before you decided to get involved I suggest that you research the industry in full and read all the books on the topic that you can. There are several books on the market but the majority of them are rather outdated so they aren't going to do much for you since the industry tends to change quickly.

For more information on medical billing work opportunities, please visit the blog sponsors bia Googele ads. You may also take a moment to visit Paul G. Hackett, who contributed to this medical billing blog post.

Tuesday, July 20, 2010

Medical Billing Work Top 5

Many health care professionals love medical billing work. The medical billing career field allows professionals the flexibility to work at home or in a medical facility. And training to become a medical billing professional can usually take less than a year.

The medical billing work field isn't for everyone; it requires patience, flexibility, and analytical skills to use proper medical codes and bill insurance companies correctly. And it's a career field for people who want to work in the medical field, but would prefer to work in the administrative side, rather than in the clinical side with patients.

If the medical billing work field sounds interesting to you, then check out the top ten reasons to work in medical billing and coding.

1. HOT EMPLOYMENT GROWTH FOR MEDICAL BILLING WORK. As you probably know, the medical billing and coding field continues to increase due to a growing need for medical procedures needed by our aging population. Every medical service requires medical billing professionals to relay procedure and cost information to health care insurance companies.

The U.S. Department of Labor recently reported that 8 out of 20 occupations projected to grow fastest are in the health care industry. They also projected that careers in the medical records and health information technician industry should increase 27% or more for all occupations through 2014.

The rise in employment opportunities is great news for trained medical billing work professionals. It means that trained medical billing professionals should have job security and lot of job growth going forward.

2. SHORT-TERM TRAINING TO WORK IN MEDICAL BILLING AND CODING Another great reason you should consider starting a career in medical billing work is because of the short-term training.

Depending on the school you attend, you can graduate with a diploma in medical billing within a year, and you can get an Associate's degree in medical insurance billing and coding within two years.

The short-term medical billing program often includes a study of:


Medical Insurance & Billing Issues
Medical Documentation and Evaluation
Government Health Care Programs
Electronic Data Interchange
Medical Insurance Claim Form (CMS-1500)
Ethical and Legal Responsibilities
The Associate's degree medical billing programs often include a study of:


Medical Terminology
Medical Office Management
ICD-9 Coding
Advanced Medical Coding
Medical Billing and Coding Computer Applications

Due to the short-term training, many medical billing schools offer day and evening classes. Please be aware that not all schools offering medical insurance billing and coding will be right for you. Before choosing a school, make sure and read the article on choosing a high quality medical billing and coding school.

3. MEDICAL BILLING WORK CAN ALLOW YOU TO WORK AT HOME Many doctor's offices and clinics don't handle their own medical billing. They will often hire an outside medical billing agency or medical billing company. Some of these agencies and medical billing work companies will hire professional medical billers who work at home to save on costs. And this is definitely an option if you decide on a career in medical billing.

It's recommended that if you decide to work at home as a medical billing professional, or decide to work as a self-employed medical biller, that you work in an office as a medical biller for a short period of time so that you will gain the confidence and skills of a seasoned medical biller.

4. MEDICAL BILLERS HAVE MANY CAREER OPTIONS Professional medical billers have a solid knowledge of the administrative side of a medical office. Depending on their education and experience, medical billers can move into:


Medical Billing Management
Medical Transcription
Health Care Administration
Data Collection
Medical Office Management
Health Information Technician

And this is just a small list of possible career paths for seasoned medical billing work professionals. These jobs will depend on your education, experience, and job market in your local area.

5. MEDICAL BILLERS CAN START THEIR OWN COMPANY Due to the high demand for medical billing professionals, some medical billers are deciding to leave their medical billing job to start their own medical billing company. This is only recommended for seasoned medical billing professionals who can find an assortment of medical offices that can become clients.

For more information on medical billing work, please visit our site sponsors. You may also visit Mike Delgado, who helped with this blog post. He is an seo copywriter living in Orange County.

Sunday, July 18, 2010

Medical Billing Work Basics

Medical billing work is a very popular work-from-home option. This line of work is a very profitable career, but also a demanding opportunity. However, if you approach medical billing work the right way, you can earn anywhere from $30,000 - $100,000 per year.

One of the main aspects to be aware of in the medical billing field is the large number of illegitimate companies trying to sell you junk. These companies disguise themselves and go to great lengths to appear legitimate. At times, some are legitimate too. The problem with many of these legitimate companies is that they will over-commit and under-deliver, rarely providing any medical billing work.

At times they will sell expensive specialized software, and other times, they will promise you lists of doctors seeking medical coding and billing service providers. Unfortunately, many of these lists are completely made up. No one wants to hand over their hard-earned money to a scammer or careless and unreliable companies, for practically nothing in return. So in pursuit of medical billing work, do your research on any company you are considering purchasing materials or services from.

Medical billing work does have some requirements, including: a personal computer, special billing software and sound understanding of industry terminology. In order to locate the most effective medical billing course, find out the individual prices for the software and the training.

The medical billing codes are the most important knowledge asset required for this line of work. The codes are assigned to practically everything, such as diagnoses, procedures, health professions etc. Apart from the codes, other important billing details include what to do if the accounts collectible are not paid by the patients or by their insurance company etc.

If you are willing to undergo a training and acquire the appropriate billing software, and are eager to work independently, medical billing work might be a good choice for you.

Time is the biggest constraint when it comes to medical billing. In fact, it is common that medical bill review professionals work 10 plus hours per day. However, don't be too aggressive in taking work, as too much work may turn into a problem in itself.

The good thing about medical billing work is that it can free you from having to report directly to a boss. If you decide to become an independent bill review professional, you will be able to work at home, close to your family, while still earning money for your household. In many instances, you will be able to earn more than with a nine-to-five job, since you will be deciding how much work to take on. If you are personally motivated and have ambitions, medical billing might be right for you.

How much work can you expect? Well this varies from company to company. Some companies require 30-50 medically coded invoices per week, others require more or less. Basically, if medical bill review is your sole income, you can decide to take as much work as you wish.

To sum it up, medical billing work can be promising if approached correctly. It lets you be your own boss, which is both a luxury and added responsibility. The work is demanding (and at times hectic), but it also pays off well.

For more information on medical billing work, please visit our site sponsored ads. You may also visit our friend Piper Wongeh, who contributed to this medical billing work blog post.

Saturday, July 17, 2010

Understanding Medical Billing Services

The below information may be advanced for those just entering medical billing work, but understanding medical billing services is a key to your success in medical billing work. As the business of running a medical practice becomes more competitive, many practices are turning to a third-party medical billing service for cost effective solutions to maintain maximum profitability. In evaluating any medical billing service agreement there is an array of factors that should be taken into consideration - pricing of services is principal among them. This article compares the two most common pricing approaches offered by medical billing services - Percentage Based Agreements and Flat Fee per Claim - and identifies some of important points to remember when selecting a medical billing service provider.

Percentage Based Agreements:
Probably the most common approach to pricing by medical billing work services is the percentage based agreement. In this type of agreement, the medical billing service's fees to the practice are based on a percentage, usually in one form or another of the following:

Percentage of collections

Percentage of gross claims submitted by the billing service

Percentage of total collections for the overall practice

With the first type above, percentage of collections, the medical billing company charges the practice only on net received for those claims in which it has directly assisted in collections (typically excluding monies collected at the office, such as co-pays, deductibles, etc.). This is the purest example of how a percentage based agreement will tie the medical billing service's success to the practice while safely limiting it to that which they have some measurable ability to affect. This type of percentage based agreement benefits the practice by its "self-policing" quality- the medical billing work service only makes money when the practice makes money.

In our second type, percentage of gross claims submitted by the billing service, the practice is charged a percentage of the total amount submitted to insurance companies and other payers. This can be tricky for two reasons. First, the rate billed to an insurance company is not always the same as the negotiated rate that will be paid. So a seemingly competitive percentage from one medical billing service can be drastically different from another medical billing work service depending on where the percentage is applied. Second, some of the incentive mentioned above is removed for follow up on claims as there is no tie-in to the results of medical billing service's submissions.

With a percentage of the total collections for the overall practice, the billing service charges for the total net received by the practice. It includes co-pays, deductibles, and any other monies collected at the office, not just by the service. This arrangement is most commonly found with full-scale practice management companies who not only handle medical billing but might also administer staffing, scheduling, marketing, fee schedule negotiations, etc. In this arrangement, the medical billing work service can be driven by incentive to follow up on claims with payers, but gains some protection to its revenues through the other sources of payment coming into the practice.

Rate Variability within Percentage Agreements:
A medical billing company will consider several variables in defining the rate charged to the practice in a percentage based agreement. Rates can range from as little as 4% to as high as 14% or even 16%! Factors influencing this variability include claim volume and average dollar amount of claims, as well as service considerations like level of follow up performed by the medical billing company, whether or not patient invoices will be sent by the billing company, and many others. Let's take a look at some examples of how these variables influence medical billing work service rates.

EXAMPLE 1:
Regarding claim volume and dollar amount, let's consider the example of practice A and practice B. Both are looking for a medical billing service offering claim generation, carrier follow up, patient invoicing and phone support. The average claim for practice A is $1000 and they average of 100 patient encounters per month. Practice B has an average claim of $100 with 1000 encounters per month. While the gross amount billed is the same, the difference is staggering for the billing company who will need to project nearly 10 times the staff hours for practice B to yield the same return as from practice A.

EXAMPLE 2:
With respect to services offered, let's consider practice C and practice D. Both practices average around 1000 claims per month, and each claim averages around $100. Now, practice C is looking for a billing service to handle complete claim lifecycle management- carrier follow up, submission to secondary and tertiary insurances, patient invoicing and support, report analysis, etc. Practice D collects patient balances at the office so they don't require invoicing services, and they plan on doing the carrier follow up themselves. Thus Practice D only requires the medical billing service generate and submit initial claims to carriers, and maybe submit a few secondary claims each month. In this example, the gross claims submitted is roughly the same, but practice C might anticipate a fee significantly higher - potentially double that of practice D - due to the extensive work involved in providing these other support services. (Keep in mind practice D will also need to consider additional staffing to perform these activities in-house, which will most likely not offset the cost of allowing the professional medical billing company to manage the process.)
These two examples clearly demonstrate the basic factors that influence the rates when considering percentage based medical billing services. While there are numerous negotiating points where a practice can save on general costs, they should consider what other costs may arise later to manage the services not provided by the medical billing work company.

Pros of Percentage Based Agreements:
Percentage Based Agreements directly tie the success of the billing company to the success of the practice if they based on collections. Practices can often choose which services they require for potential short term savings.

Cons of Percentage Based Agreements:
Short term savings garnered by keeping some billing activities within the practice can lead to long term costs in additional staffing. Small claims may not be addressed as vigorously. For example, consider a $5.00 patient invoice with a medical billing service charging 8% on collections. The medical billing work service would actually lose money in pursuing the claim. Adding up the cost of postage, envelope and paper, as well as staff time for printing, stuffing and mailing, it would be more than the $0.40 that would ultimately trickle back to the service.

Flat Fee per Claim:
Another common approach to pricing offered by medical billing services is what we'll call Flat Fee per Claim. With flat fee pricing the medical billing company charges a fixed dollar rate for each claim submitted, regardless of the size of the claim.

Similar to percentage based agreements, flat fee per claim pricing can vary significantly depending on the volume of claims and the extent of services provided. In its most basic form, a fee per claim medical billing service might provide only claim generation and submission services for as little as a dollar or two per claim. In this case it would be the practice's responsibility to follow up on claims. Of course flat fee per claim pricing can also include other services such as follow up with carriers, patient invoicing, etc. With these additional services, practices might expect costs to increase to $4, $5 or even $7 per claim or more.

Dependent on the practice, the flat fee per claim can be cost effective, but should be considered carefully. Follow up with insurance carriers and the bureaucratic problems should not be overlooked. In some cases, once the medical billing company has submitted a claim, they might make a phone call or two; but they've done the submission and the transaction is billable to the practice, regardless of how it's paid out. Fee per claim pricing doesn't have the inherent incentive like some types of percentage agreements. Nonetheless, it can be the solution if you have the resources to manage the follow up, or if your familiarity with the medical billing work service is strong enough to trust in their follow up.

Pros of Flat Fee per Claim:
Fee per claim pricing has the potential to be more cost effective, particularly on higher priced individual claims.

Cons of Flat Fee per Claim:
If carrier follow up is included with this service, the medical billing company has little incentive once the initial claim has been submitted. Moreover, it can be near impossible to evaluate how rigorously a medical billing service is following up. If carrier and payer follow up is not included with the service, the practice must manage it in-house. Inevitably, hiring and training new staff or allocating time of existing staff leads to increased overhead, often offsetting the benefits of using a medical billing work service in the first place.

Hybrid Approach:
The final example in this discussion is what we'll call the Hybrid Approach, which takes advantage of percentage based agreements and flat fee per claim approach. Through this pricing method, a medical billing service might apply a percentage to certain insurances and patient balance bills, then apply a fee per claim for others. This approach is usually siloed by carrier or claim type, in that it would use the percentage for all claims to carrier X, and flat fee for all claims to carrier Y.

The hybrid approach has become more common in certain areas of the US over the past several years as some insurances frowned upon percentage based agreements. An example was seen when the state of New York rendered percentage contracts on state Medicaid claims illegal, requiring medical billing services use the flat fee per claim option. The principle concern arises from a few unscrupulous billing services who believe "up-coding", or submitting false claims for higher priced services, is the easy way to increased profits. While these few services threaten to tarnish the reputation of an entire industry, those bona fide medical billing services seeking long-term growth and profitability clearly realize that small gains won from illegal activities are no way to sustain a successful business.

In short, the hybrid model allows honest billing companies the chance to tie their successes to that of the practice while respecting the concerns of those insurances guided by formal legislation.

Summary
When medical providers and practices consider teaming with a medical billing company, they have an array of options. Flat fees per claim may appear more cost effective in the short-term, but the potential for revenue interruption due to poor follow up by the medical billing service provider, or the need to hire and train additional in-house practice staff to handle the follow up on its own, will undermine the initial cost savings to the practice. Agreements based on a percentage of collections are self policing and ensure the medical billing work service will pursue reimbursements rigorously. For related information, visit Diversity Technology Medical Billing.

Saturday, July 10, 2010

The Medical Billing Handbook

A Medical Billing Resource:

Written by the founder and Executive Director of the National Electronic Billers Association (NEBA), the largest medical billing organization in the country, this Medical Billing Handbook is a comprehensive and authoritative overview of medical billing as a business. This resource is a comprehensive overview to medical billing work - what you need to know and how to get started when building your own medical billing work business. Medical Billing Handbook topics include: how to use medical billing software, gaining medical offices as accounts, maintaining relationships with your accounts, and much more. Anyone interested in going into medical billing work would be advised to pick up a copy! The book offers:

>Hundreds of tips from Medical Billing Professionals
>Software demo
>AltaPoint demo, another practice tool
>A chapter on medical billing work from home


Get off to the right start in preparing for your medical billing career by getting a copy of the Medical Billing Handbook. As always, we welcome all feedback on your medical billing work experience!

Friday, July 9, 2010

Free Medical Billing Software

We often get questions from our blog readers about medical billing software. Specifically, people wonder if there is any free medical billing software available. We did some research and uncovered a few sources of free medical billing software. Most of it is web based and online. If you are working from home doing medical billing work, you will definitely need some type of medical billing software. When doing medical billing work for a Dr's office, clinic, or other medical facility, then you will of course use their proprietary medical billing software. The below, however, is for those bold folks who are doing medical billing work for
themselves and are seeking a good source of free medical billing software.

Free Medical Billing Work Software

Free HIPPA is a web based application that allows anyone with an Internet connection and browser the means to access billing software regardless of geographic location.

Avinsnea also offers free medical billing software. Avisena offers a free practice management software and free medical billing software suite provided you are a client. There are never any user fees, upgrade fees, or maintenance costs with this medical billing work solution.
All you need is a computer and Internet connection (Internet browser and a standard DSL connection).


FreeDOM is is a good choice for a small office or individual doing medical billing work on there own. FreeDOM was specifically designed to be the complete solution for smaller medical offices. This medical billing work software is both an EMR and a practice management system, so your staff needs to learn just one product. It is easy to learn and easy to use. Most importantly, FreeDOM is FREE for offices with one, two, and three providers.
There is no purchase price, no licensing fees, no maintenance fees, no subscription fees. If you decide that FreeDOM is no longer the right solution for your office, you can stop using it any time you like.

Please contact us with other sources you find of free medical billing software. Also feel free to contact us or post comments on other medical billing work topics. We welcome your feedback!