Frequently asked questions
Do I have to be a certified biller to start my own medical billing business?
No, but it is recommended that you take our specialized training course to operate your own Medical Billing Business.
Do I have to be an American citizen to start?
No, but it is recommended that you legally set your company up in America and take our specialized training course to operate your own Medical Billing Business.
What Is Medical Billing?
By now, you've heard the term "Medical Billing," and you know that people can earn a great income doing it, but you're not sure what it is. "Medical Biller" can be a very broad term, so ill explain it in the simplest way I can:
The process involves submitting and tracking medical insurance claims; to insurance companies for the services provided by medical providers, such as doctors, therapists, chiropractors, etc.
Let's look at a simple scenario to see how the process might work.
Let's say a person has to go to the Doctor because they have a sinus infection.
They first need to find a doctor who accepts their insurance, they get to the office, check-in with the receptionist, they present their insurance card, the Doctor sees them, and they check out by giving the receptionist their insurance co-pay.
So far, the Doctor has only received a small portion of the fee for his/her service.
It's up to the Doctor to send a claim to the patient's specific insurance company to collect the other portion of the fee covered by the insurance company.
This is an extra step the Doctor has to take if they want to get paid all of their money.
Most Doctors are too busy seeing patients all day. They would rather be practicing medicine than doing paperwork anyway, so they chose to find someone capable of overseeing this billing process.
This process usually consists of hiring additional employees who work inside their medical office, working specifically on this process. Those additional employees create a new (In-House) billing department.
In many cases, the Doctor would rather not have to deal with this part of their business, so they hire an outsource billing service to take care of it for them.
Individual Doctors, hospitals, clinics, laboratories, therapists, specialists, treatment centers, and anyone else who accepts insurance goes through the same process.
So, you could sum up Medical Billing as – the process of collecting payments from the insurance company for the Doctor or Service Provider. That's what it is!
If you wanted to work in the Medical Billing field, you could become an employee and work in a Doctor or Service Provider's office or for a billing service.
You also have the more profitable option of starting your own Medical Billing Business.
1. Running a Medical Billing Business:
This section explains what is involved in starting and running a medical billing business.
It will explain the different types of business structures available and the resources needed when starting a business. The course explains the requirement of a practice management system as well as the different options available when selecting one.
It will also discuss the other equipment necessary. The course will also explain the importance of contracts that the billing service will need to have with their providers and what needs to be included. Another important topic of how to price your services is addressed as well as the importance of marketing.
2. The Guide to Medical Billing:
The purpose of this section is to explain what is involved in starting and running a medical billing business.
It will explain the different types of business structures available and the resources needed when starting a business. The course explains the requirement of a practice management system and the various options available when selecting one. It will also discuss the other equipment necessary.
The course will also explain the importance of contracts that the billing service will need to have with their providers and what needs to be included. Another important topic of how to price your services is addressed and the importance of marketing.
3. Practice Management Systems:
This section will teach the student about how information must be input into the practice management system in order for billing to be done properly.
It will explain the importance of the billing entity verses the practice information.The student will learn how to input practice information, rendering providers, office locations and facility information.They will also learn how to set up insurance companies and clearinghouses in order to submit claims either on paper or in electronic format.
The course covers entry of patients, diagnosis codes, and procedure codes as well as referring providers.The student will learn how to enter encounters, post payments, made adjustments and input notes into the system.The process of creating electronic files and printed paper claims as well as sending patient statements is covered.
Finally the student will learn about running reports and following an audit trail.Practice management system NowMD is used to demonstrate to the student how this information is entered and how these tasks are completed.
4. Life Cycle of an Insurance Claim:
This section introduces the student to the information necessary to complete the task of processing a medical claim.
The information-gathering process begins when the appointment is made. This unit explains what information is needed and at what point it is obtained. This unit also covers common forms used in the medical office, such as patient intake forms, encounter forms, HIPAA, and privacy statements. Unit Objectives After completing this unit:
You should be able to:
Identify the provider or practice information that must be entered into the Practice Management System before medical billing being entered.
Identify the items required on forms that are used in the medical practice.
Recognize cases relating to a work or auto injury. Identify common forms that providers require patients to sign.
Understand the importance of verifying current information with the patientKey.
The medical billing process begins when the appointment with the medical provider is made. Certain information must be obtained from the patient before the patient, even being seen for the medical billing process to run smoothly. When the patient arrives in the office, additional information is obtained and verified. Forms need to be signed and placed in the patients’ records, and patient information must be verified regularly.
This section will give the student a detailed overview of HIPAA, the Health Insurance Portability and Accountability Act of 1996.
The student will learn why HIPAA was created and what it was designed to do. This unit explains how HIPAA is broken into five sections and the purpose of each section. The student will learn about fraud and abuse, along with examples of each and what the penalties may be.
This unit explains the Medicare Integrity Program and the Unique Identifiers established by HIPAA. Electronic Transaction Standards are presented, along with HIPAA’s privacy and security regulations. The student will also learn what constitutes personal health information (PHI) and how it must be protected
This section is about Blue Cross and Blue Shield.
You will learn about
Automobile Accident Insurance
personal injury claims
You will learn about the history of Blue Cross and Blue Shield and the different types of plans offered by them.The course also covers the different types of individual and group commercial insurance plans.
You will learn about the different techniques used by managed care plans with the intent to reduce the cost of health care while improving the quality of care.The course explains how Workers’ Compensation insurance provides medical coverage for employees who are injured while on the job.The course covers how automobile insurance may be responsible for medical services that are received as the result of an automobile accident as well as personal injury claims.
COBRA is explained along with the impact of the Affordable Care Act may have on it.
This section will cover information on reading remittance advice and understanding how to interpret the information.
Different formats of remittance advice such as paper EOBs, ERAs, and MSNs are introduced. The course also explains the importance of correctly entering the remittance advice data and how incorrectly entered information can affect the billing process.
This course includes information on how to handle errors on the part of the insurance carrier, correcting claims filed with incorrect information, how to address common denials, and how to file appeals on denied or incorrectly paid medical insurance claims.
The course also covers how to track appeals and adjustment requests and the storage of remittance advice and information on how long they must be kept.
8. Medicare & Other Government Insurance:
This section will teach the students about Medicare, the federal health insurance plan established by Congress for seniors, and certain people with disabilities.
The course covers all four parts of Medicare and the intricacies of the complex Medicare billing system. The student will learn the covered services of Medicare Part A, B, and C(Medicare Advantage Plan)and how Medicare for working people is handled. The course will teach about Medicaid and how each state is responsible for designing and maintaining a program that provides medical services to low or no-income families.
The student will learn about TRICARE, the program designed to provide health care services to military members and their families. The course covers the four regions of TRICARE and the different types of TRICARE coverage available.
9. Medical Coding:
This section will focus on the building blocks of the language of medical coding; diagnosis codes (ICD-9-CM and ICD-10-CM: International Classification of Diseases), procedure codes (Current Procedural Terminology), and the national HCPCS:
(Healthcare Common Procedure Coding Systems). Modifiers, which are specific digits that are appended to the procedure codes, are reviewed as well. This course will allow the student to apply medical codes to specific claims using the standard CMS-1500(rev 02-12)for this purpose and use coding references to familiarize themselves with the coding process. Evaluation and management codes (E&M codes), as well as medical decision making, which refers to the complexity of establishing a diagnosis and procedure(s) for a patient, will be reviewed.
Though a medical biller does not usually do any coding, the student needs to know how the physician determines the codes for submitting to the insurance company and documenting these codes in the patients' medical record. The course also explains and discusses the practices of Bundling and Unbundling and upcoding and down coding. Medical terminology relevant to these coding systems that are used for medical billing will be covered.