≡ Menu

One of the most important things any medical biller or coder should be aware of is regulations regarding the industry. Laws that govern the healthcare industry can come from the federal, state or local level. In addition to legal issues, billers and coders must also deal with rules imposed by payers, accreditation agencies and their own employer. The volume of regulations can make anyone’s head spin, but it is important to follow all laws. After all, no one really looks good in an orange jump suit!

Although it is unlikely someone in a billing or coding career would ever be arrested due to actions on the job, failure to follow rules and regulations can result in financial loss for the company and in loss of your job. Here are some tips to ensuring compliance at all times in your medical billing or coding career.

Know the Big Rules

No one can remember all compliance rules in a medical job, but everyone should commit a few of the biggest to memory. The most important rules in each organization should be provided during orientation or training, but here are a few that are universal to healthcare.

  • Health information is private. You cannot share any information that could identify a patient with any other entity without the express written permission of the patient. This means that if your adult cousin is a patient and you bill her claim, you cannot discuss the information with your aunt. In fact, you should probably not even discuss the information with your cousin, as you are not her healthcare provider.
  • Health information is need-to-know. You should not discuss information within your organization unless there is a productive reason for the exchange.
  • Passwords are unique to you. You should never share log on information for any program you use at work, and should not write passwords down.
  • Claims should accurately reflect services rendered. Falsifying claims to increase the amount of collections is a federal offense.
  • The portion of any charge that is the patient’s responsibility usually cannot be waived without an attempt at collection or documentation of indigence.

Use Available Resources

If you are working for a large company or hospital, you likely have access to legal, compliance and knowledge management departments. Most of these departments have open door policies, help lines, email addresses and anonymous communication lines. Any time you are in doubt regarding the compliance of an action, you should check with these resources. You should not break chain of command, however. When searching for an answer to any medical billing or coding question, there is a process to follow. You should:

  1. Check your training materials and notes;
  2. Check with your supervisor or trainer;
  3. Check with your manager;
  4. Check with a compliance contact that can elevate the question if no one can provide an answer.

Take Accountability for Your Work

You should never complete any task that you believe to be against the law. If your supervisor or manager has directed you to complete such a task, you should ask to speak to them in private. Calmly provide them with an explanation regarding why you think the task is illegal or questionable. Sometimes, you may be misunderstanding the work, and they can offer guidance. If they cannot provide a satisfactory explanation on how the work does not break any rules or regulations and they insist you complete the task anyway, you should contact the compliance helpline for assistance. Most companies have a no-retaliation policy to protect employees who bring up compliance concerns of this nature. However, in very rare circumstances, you may have to make a choice between keeping your job and abiding by your ethics. In these cases, it is usually better to seek employment in another facility that will not ask you to break rules.

{ 0 comments }

Supervisors and bosses can be wonderful, horrible, or somewhere in between. This is true of all occupations, but can be especially noticeable in the medical billing and coding field. Demands for quick claims processing and medical records management clash with the need for quality and compliance. Management usually has to explain any mistakes to a committee of reviewers just moments after answering to operations executives about process efficiency. Often, the heat is passed from management to the billers and coders themselves.

What Not to Do in Bad Situations

When tensions are high and your boss is demanding, you may be tempted to act rashly. Several behaviors come naturally to many in these situations, but individuals often regret such actions later. Here are five things you should never do in a moment of tension or dissatisfaction with your manager.

  • Do not quit your job. Walking out in a moment of tension is both unprofessional and poor decision making. At the very least, allow the issue to cool down before making a decision to quit. After the storm blows over, you may find there is not a desire to change occupations after all.
  • Do not send an email while angry. Allow yourself to calm down before you send a scathing email and copy it to every vice president in the building. If there is someone you can trust, ask for a private conversation just to vent. Communicating your frustrations in private allows you to blow off steam. Then, you can send a much calmer, professional email detailing the problem.
  • Do not sabotage the situation. Sending incorrect claims, falsifying information or any other negative action in response to a poor work environment will only get you in trouble.
  • Do not confront your boss in front of others. If you have a serious problem, ask for a private meeting.
  • Do not break chain of command unless command is unresponsive. Before going above his or her head, make sure you have tried open, honest communication with your boss. Never communicate the problems to other staff members, as this is a form of gossip.

What You Should Do

Medical billers and coders are responsible for the accuracy of medical records information and claims. Incorrect information can influence company payment and profitability, putting everyone’s jobs in danger. Even worse, inaccurate information on a patient’s file can lead to injury, additional health issues and even death. It is imperative that medical billers and coders act professionally and attend to their job with excellence, no matter what is going on in the business around them. Here are some things you should do if you are having boss problems in your medical billing and coding career.

  • Continue to complete work with integrity. An issue with your boss is not connected to your responsibility to provide accurate medical information in records and claims.
  • If your boss’s actions are impeding your ability to complete accurate work and attempts to resolve the issue directly have gone unanswered, report the situation in private to your department head, human resources representative or compliance officer.
  • Be discreet about any issues once you have reported them and comply with senior management or human resources requests.

It can be stressful to be involved in an issue with your supervisor or boss. Often, the stress leads to actions that make the problem worse. When stress levels reach boiling points, take a break and walk around the parking lot for a few minutes. Vigorous walking is a great release for nervous energy. A healthy, high-protein snack can also provide a break in routine. For a quick spa treatment right in the office, wash your hands in the restroom. Then, run alternating hot and cold water over your fingers in intervals of about 15 second each. You will feel refreshed and ready to face the challenge of stress for the rest of the day.

{ 0 comments }

Medical Coding and Billing from Home

Medical Coding and Billing is a very interesting and rewarding healthcare field. In the present times, the demand of healthcare professionals has greatly increased. They are required in different clinics labs, nursing homes and hospitals. Other than doctors, nurses and other technical staff, medical centers also need medical billers and coders. This is why job opportunities in this field have greatly increased. As soon as you complete your training in medical billing and coding you can readily find several job opportunities and earn handsome salary. For this reason, more and more students are seeking to get training and medical billing and coding.

There are various regular as well as online schools that offer different training programs in medical billing and coding. These programs include certificates as well as degrees. The certificate courses in medical billing and coding can be earned in three month to one year. Degree programs, on the other hand, can be completed in four years. Most students prefer to go for a certificate program in this concentration. Earning a certificate in medical billing and coding certificate can lead students to entry level position in different hospitals and other health care settings. Associate degree and bachelor degree can lead you to more rewarding job opportunities in the world of medical billing and coding.

The choice of a learning route depends on the individual preference of a student. However, the trend of pursuing the program online has increased over the years. This is because distance learning programs provide students with the lot of flexibility compared to the regular degrees. Also, online courses in medical billing and coding are more affordable than campus based courses. Students can enroll in these programs in any location and complete them at their own pace. They do not have to attend classes in person or study at fixed hours. Because of all these benefits the online program in medical billing and coding make a great option for working professionals who want to become medical biller and coder. They can enroll in these courses from the comfort of their home and study at their own time. Thus getting into distance learning program provides them with a convenient way of earning valuable certificate and degrees and boosting their career in a great way.

Medical billers and coders are basically responsibly for keeping the record of patients. They also look after the payment process and coordinate with the insurance companies. Training programs in medical billing and coding allow students to know how to handle software programs in addition to managing several administrative tasks. Thus you need technical as well as non technical training to become a successful medical biller and coder.

Even though there are several campuses based as well as online colleges offering training programs in medical billing and coding not all of them are equally good. There are various factors that you need to consider while choosing a medical billing and coding school. These include the cost and duration of the program, the general reputation of an institute and the accreditation of a school. One must get into an accredited school so that he or she can earn degrees that have wide acceptance job in the market.

It will also allow you to get quality education and pursue a rewarding career in this field of specialization. The reputed schools also enable you to avail financial aid opportunities. They offer scholarships, grants, employment and student loans which enable students having different financial background to easily afford the cast of education and become a medical biller and coder without any problem.  

{ 0 comments }

Online Medical Billing and Coding Jobs and Their Demand:

The realm of medical billing and coding encompasses a multitude of job opportunities where aspiring individuals may seek exciting careers. The job levels vary according to the individual’s skill sets and knowledge base. From mere administrative support in numerous private or public health care facilities such as clinics, hospitals, health insurance providers etc, you may even advance to levels of audit specialists, billing coordinator, billing manager, billing supervisor, coding manager, coding professional, coding specialist, denial/appeal specialist, medical record supervisor, reimbursement specialist etc. The monthly salaries vary according to the job title and responsibilities, typically from $30K to $85K and sometimes even more.

Healthcare is one of the primary concerns in many countries around the globe. As the field of medicine advances we witness greater need for medical professionals and an even greater demand of new job openings. With so many jobs already available in the field, it gives one furiously to think about the growing demand in the next few years. In addition, aspirers working at the beginner level may well proceed to higher levels in the same field through numerous training programs and courses that are available.

For those individuals who wish to work as a medical biller or coder from within the confines of their homes, the industry has evolved various opportunities and vacancies for the same. The job responsibilities of a medical biller and coder vary from each other despite running parallel in their executions. However, a medical biller may very well be capable of working as a medical coder and is often termed as a medical insurance specialist.

Of course for online jobs, the billers and coders are kept on contract basis implying that the handful of perks associated with permanent job positions such as those involving annual leaves, bonuses and medical insurance are not given.

Online medical and coding jobs are increasingly gaining popularity owing to the rapid expansion of health insurance companies and facilities alike. Such companies tend to distribute the heavy influx of work load to independent or self employed coding specialists who are required to complete the work in a specific time frame. The guidelines and working instructions are given in accordance to the company’s desired standards of both quality and accuracy. For online medical coding and billing jobs, the need for efficient medical coding software is a must. Most companies seeking independent contractors provide their coders and billers with the required software and sometimes even hardware.

Online medical and billing jobs give individuals the freedom to work from their homes, in their own comfort zones. Also, these jobs give them the opportunity to adequately divide their time between work and family or other chores, without the additional delays of travelling. Home based medical coders and billers also end up saving more as compared to jobs that require daily expenditure on transportation, food, attire etc.

The basic requirements for the job are good organization skills along with the ability to multitask, a working computer with internet access, medical billing and coding software and a tracking program.
As a medical billing and coding professional you need to be well aware of the changing nature of the industry you are working in. As technological advancements evolve businesses to a whole new level of ease, adapting to these changes in a proactive manner is the need of the hour.

Medical field and health insurance are two areas which continue to fuel each other’s growth. The business trends are shifting towards e-commerce due to lower associated costs. At the same time medical coders and billers now need to face the challenges of tougher rules and regulations such as those of HIPAA (Health Insurance Portability and Accountability Act). 

{ 0 comments }

Many people new to the medical billing and coding industry believe these two functions are the same thing. In reality, many companies treat the jobs separately, although the skills sets are closely related. This article provides a detailed description of each function and a brief overview about what sort of job opportunities are available to individuals with medical billing and coding experience.

Medical Billing

Medical billing refers to the work completed by a provider of healthcare services in order to receive payment by insurance companies and patients. Often, this is referred to as claims adjudication. Although details within the process for each provider or treatment type vary, the basic premise for billing remains the same throughout the industry. This means someone with medical billing education or experience can adapt their knowledge to a growing variety of job opportunities.

Medical billing work consists of the creation, transmission and follow up of insurance claims and patient statements. Depending on where an individual works, daily functions performed in the scope of a claims billing job might include:

  • Preparing electronic or paper claims;
  • Data entry;
  • Reviewing claims to ensure quality;
  • Checking medical records to ensure documentation requirements are met;
  • Calling insurance companies or physician’s offices to clarify information;
  • Entering claims online;
  • Checking claims status online or via telephone,
  • Following up on non-paid claims,
  • Speaking to patients regarding information for claims;
  • Following up with patients on outstanding invoices; and
  • Re-filing claims.

Small providers and offices usually have one or two staff members who complete all billing work while hospitals and large providers have entire departments dedicated to this task. There is usually more room for moving up with a larger provider, but smaller offices allow for diversity of work.

Medical Coding

Medical coding is the process of using an alphanumeric coding system to indicate procedures and diagnosis in a patient’s medical records. These codes are used to standardize medical communications for clarity among practitioners, as well as to transmit information to insurance companies for payments. Proper coding is essential in today’s technologically advanced health care environment. The diagnosis, procedure and medication codes are entered into systems at hospitals. The system uses the codes to ensure medications will not interact negatively with each other or the patient. Coding also ensures that procedures ordered are applicable to the diagnosed condition. Failure to property code items can result in improper care and injury to the patient.

Accurate coding is also required for payment of claims. For example, if a claim is submitted with a gender of male and the diagnosis code is related to pregnancy, the claim will not go through. Similarly, claims with procedure codes that are not deemed relevant to the diagnosis will be denied.

Medical coding is closely related to medical billing. In some offices, the same person performs the functions. In hospitals and large facilities, there are often separate medical records departments that employ coding experts.

Medical Billing and Coding Job Opportunities

Health care administration is one of the fastest growing careers in the country. As insurance companies attempt to save costs, accurate and efficient claims filing processes grow in importance for all providers. Someone with education or experience in medical billing and coding can expect to find job opportunities in hospitals, physical therapy clinics, physician’s offices, optometry and dental offices, rehabilitation facilities, nursing homes and off-site medical consulting firms. Medical billing clerks make an average of $22,000 to $32,000 per year in the United States. Certified medical records and coding experts can make up to $50,000 per year on average.

{ 0 comments }