Before we know what medical billers do, we should familiarize ourselves with the term medical billing and medical billers. Medical billing is the process of submitting and following up on claims with health insurance companies to receive payment for services rendered by a healthcare provider. Medical billers are responsible for submitting medical claims to insurance companies and payers. They play an essential role in the link between insurance companies, health care providers and patients.
What medical billers do
A medical billing company enters information on the medical claim into practice management software. The biller typically assembles all data concerning the bill. Medical billers communicate with doctors and other healthcare professionals regularly to clarify results or to get extra information. The information included is of the patient, physician, the insurer or payer and the medical billing and coding. The standard codes used depend on the type of medical practice, and they include:
· CPT codes (Current Procedural Terminology)
· CPT modifiers (Current Procedural Terminology)
· ICD codes (International Classification of Diseases)
Roles of medical billers.
They communicate between the related parties. Medical billing companies are responsible for researching the best payers or insurance companies. They prepare claim appeals as necessary, research on insurance companies and payers and submit the requests. For good medical billing companies to avoid getting tied up in costly back-and-forth appeals with payers or insurance companies they ensure to get correct information the first time. They keep low claim denial rates or low percent of claims that get resubmitted.
They re-submit or adjust claims with mistakes and appeal denied claims
Where requests are denied and need to be changed or come back unpaid, medical billing companies correct any errors and make the necessary adjustments or clarifications after which they re-submit the claims.
They collect payment from insurers and patients and also post any further bills to patients.
Medical billing companies interpret and post the EOB (Explanation of Benefits) received from insurers. They are the most capable people to answer any questions from the patient. They strive to decrease the time between treatment and the final payment of the bill.
Reduce the risk of the poor financial health
Medical billing companies reduce the risk of having poor financial health by understanding a list of things. By understanding fair debt collection practices which are:
· They should have evidence of the debt by documenting a claim with a copy of an unpaid bill or any other evidence of a payment violation.
· They should not oppress or abuse the patient by any means.
· They should not use false statements, misrepresentation, unfair practices or misleading threats on patients.
· They are not allowed to garnish wages or give any information about the patient to anyone.
By upholding professional courtesy regulations such as; not charging peers, their families, and their staff for health care. They should have clean claims over the debt. Timely filed guidelines are also required. The medical billing company should not lack any requested document and should not have any circumstance that prevents timely payment. By meeting all refund requirements and other regulations.