Healthcare practices must all operate according to a payment process that guarantees physicians will receive payment correctly and promptly for services rendered. Medical Billers perform the function of managing the financial integrity of practices while physicians deliver patient care. What does a Medical Biller do? What makes it an important role in the Healthcare System today? Our work at MGSI involves providing support to Healthcare Providers throughout the United States to improve the efficiency of Revenue Cycle Operations and our relationship with Medical Billers. Understanding what a Medical Biller does will help Healthcare Providers understand why having accurate billing is essential for their financial survival.
Defining a Medical Biller’s Role
The duties of a Medical Biller are to convert Healthcare Providers’ services into a standardized format for billing that can be submitted to Insurance Companies and Government Payers. The goal of the Medical Biller is clear: they want to ensure Healthcare Providers receive the correct amount of reimbursement for the services they perform.
The Medical Biller is the intermediary between the Healthcare Provider, the Payer, and the Patient. In order for them to do this effectively, they need to know how to code services correctly, know the rules of each Payer, adhere to Compliance, and perform their functions accurately and efficiently.
What Do Medical Billers Do?
While billing is an important part of a medical biller’s job, it is just one element of what they do.
Transforming Provided Medical Services into Billable Claims. Medical Coders provide Medical Codes, which are used by Medical Billers to generate Accurate Claims based on the medical services actually performed. Medical Billers need to pay attention to detail, and also have a firm understanding of the Special billing rules established by each individual Payer.
Submitting Claims for Payment to the Insurance Companies, Medicare, or Medicaid. A Medical Biller submits claims electronically or manually for payment from the various Insurance Companies (Medicare, Medicaid, etc.). A Medical Biller must submit the claim in the Correct format and the Correct amount of time; otherwise, the Claim may be rejected.
Tracking Claim Status. The job of a Medical Biller does not end once the claim is submitted. Medical Billers must continually track claims and follow up on any payments pending while also monitoring for any issues that may cause a delay in receiving payment.
Denial and Rejection Management. Any denied or rejected claims require immediate attention by the Medical Biller to ensure that the issue has been resolved in order for the Medical Biller to attempt to recover any lost revenue because of the denial.
Patient Billing/Statements. Another responsibility of the Medical Biller is to bill Patients for any Balance Owed by the Patient not covered by the Insurance Company and handle all inquiries related to Billing professionally and in a manner that is clear for the Patient to understand.
The Importance of Medical Billers for Health Care Providers
Revenue generation depends on medical billing. Poor medical billing practices can cause even the most successful health care providers to fail financially. Medical billers help providers with:
1. Maintaining steady and predictable cash flow.
2. Minimizing the number of claim rejections and delays in payment.
3. Ensuring regulatory compliance with rules governing health care.
4. Maximizing the gross revenue cycle through revenue cycle operations.
Through our years of service with MGSI, we have seen how timely and accurate billing can help stabilize and grow health care providers financially.
The Necessary Skills to Become an Outstanding Medical Biller
Medical billing is both technical and analytic. An excellent medical biller will usually possess:
1. Thorough knowledge of the various rules and regulations that govern medical billing.
2. A basic understanding of payer and insurance company guidelines.
3. A Commitment to Detail and Accuracy in Bill Processing.
4. Problem-Solving Capabilities
5. Knowledge of Billing Software and Electronic Health Record (EHR) Systems
6. Good Communication Skills for Interfacing with Patients.
The ability to learn continuously is also essential to this occupation, especially as regulations and payer requirements are added and/or changed frequently.
Medical Billing vs Medical Coding: What’s the Difference?
While medical billers and medical coders often have similar responsibilities, their respective functions are quite different from one another.
Medical coders use the medical documentation supplied by a provider to translate that data into the appropriate coding format (ICD, CPT, HCPCS). Medical billers process, submit, and follow up on health insurance claims by using the codes provided by the medical coder.
Together, medical billers and medical coders are key to the successful functioning of the medical billing cycle.