EMR:  Electronic Claims Are No Longer the Future But the Present!

EMR: Electronic Claims Are No Longer the Future But the Present!

Medical insurance billers (MIBs) once dreamed of a modern way to submit claims that eliminated paper records and allowed claims to arrive almost instantly at their destination.

With electronic medical record (EMR) technology, the future is now. In this informative article, EMR expert, Nitin Chhoda, explains what billers need to know about electronic claim software.

EMRMIBs have the option of purchasing billing software or an EMR for their company’s needs. EMRs offer a wider range of functionalities for use in the 21st century medical billing enterprise.

Modern and convenient, they provide the critical security measures and protections mandated by HIPAA for the transmittal of reimbursement claims.

Counting Costs

Medical billing software costs range from $500 to $5,000. EMR technology can be obtained from reputable sources, with monthly user fees as low as $49. Both types of software systems accomplish the same objective, but EMRs offer other functionalities that can make a biller’s job easier and enable them to offer additional services.

Claims and Security

The Affordable Health Care Act mandates that billers submit reimbursement claims electronically. Claims that aren’t will be denied. Submissions must also conform to HIPAA security regulations for transmitting medical data. EMR software complies with both of those goals, has built in safeguards to protect patient information, and will alert everyone within the network in the event of an attempted breach.

Coding and Billing

The upcoming transition to ICD-10 codes has many in the medical field concerned about revenue disruption. Electronic medical records are capable of handling the addition of all the new codes and insurance plan modifications with efficiency and finesse, including those used outside the U.S. Most billers won’t encounter the foreign coding, but an EMR allows MIBs to be prepared.

Billers must implement HIPAA’s 5010 transaction standards for digital transmissions before utilizing the new codes.

Document templates can be created for any practice or specialty with an EMR, and can be modeled on documentation with which staff members and billers are familiar. The systems can be integrated with other clinicians, pharmacies and medical facilities for referrals, prescriptions and diagnostic testing. The full complement of documentation is available to billers for clean claims that are approved quickly.

Modern CommunicationsEMR system

Many billers are tasked with monitoring and tracking the financial accounts of their clients’ patients.

An EMR allows MIBs to communicate with patients through multiple means that includes phones and mobile devices, mail and email, and text and voice messages.

MIBs can remind patients about outstanding balances and monitor if deductibles and co-pays have been met.

Electronic claims are no longer a futuristic dream. They’re available now with instantaneous and secure transmissions that conform to the Affordable Health Care Act and HIPAA.

The multi-functionality of EMR software allows MIBs to painlessly integrate the new ICD-10 codes, collect client revenues quicker, and offer all the services practitioners require.

Medical Insurance Billers: How to be Better in Business

Medical Insurance Billers: How to be Better in Business

Every entrepreneur dreams of launching a successful business, but many are at a loss once the goal has been achieved. Medical insurance billers (MIBs) may be tempted to rest on their laurels once they’ve made it to the “big leagues”. In this revealing article, Nitin Chhoda provides medical insurance billers with helpful advice when they’ve outgrown their home-based business.

medical insurance billersIt’s easy to let day-to-day operations slide a little in the excitement and chaos of moving to an outside office.

Joining the ranks of highly visible businesses means medical insurance billers will need to work twice as hard and employ every tool at their disposal to attract and retain new clients.

Location Isn’t Everything, But It Helps

It’s tempting to rent office space in a highly visible venue, but it may not be the best solution for the budget. Discount pricing doesn’t necessarily mean a low-rent district. It’s possible to strike an equitable deal for space in under-utilized structures.

Many business owners are choosing to rent a home to house their enterprise. It can offer a cost effective solution that provides a user friendlier atmosphere. Medical insurance billers that take this route should check local laws and ordinances to confirm they can legally conduct business from the location before committing to a specific property.

Appearance Counts

The face a business displays to the public has a significant impact on clientele. Potential clients that see a structured and organized office will perceive the business as professional and the medical insurance billers as someone who are efficient and get results.

Accommodate the Customer

Business expansion dictates that the MIB assume new clients and that may necessitate moving out of their comfort zone to land new accounts. They may be asked to provide services not currently offered. Medical insurance billers should always be willing to learn new things and do whatever is necessary to accommodate clients.

Medical insurance billers should endeavor to provide the customer with what they want, as long as they have the appropriate professional skills and knowledge to do so.

Growth and Expansion

Medical insurance billers typically move out of their homes and into the public domain when their customer base will support it. Beware of rapid expansion and acquiring too many new clients. The result is an MIB that feels overwhelmed, with the inability to provide each client with the personal attention they deserve. An over-abundance of work entails hiring additional staff that may require significant training.

Be realistic when planning goals and anticipating revenues. Always expect the unexpected, from replacing equipment and hiring staff to unforeseen accidents. Medical insurance billers may need to increase their rates, but use caution or run the risk of losing even established clients. Think quality, not quantity.

MIBsThe Little People

Being charming, gracious and accommodating is easy when physical therapy billing business owners are seeking their first clients.

The same rules apply when medical insurance billers are at the helm of a growing enterprise. No business owner should ever forget the individuals, clients and subsequent referrals that helped them reach their current level of success.

Insurance Lingo: Learning to Talk the Talk of the Medical Billing World

Insurance Lingo: Learning to Talk the Talk of the Medical Billing World

Medical insurance billing encompasses much more than entering numbers in a pre-made form. Medical insurance billers (MIBs) must have a strong working knowledge in a variety of fields and understand the many terms they’ll encounter.
Whether MIBs choose to work in a medical facility or launch a home-based business, they’ll find it extremely difficult to find employment or clients if they’re not familiar with the terms of the trade. Nitin Chhoda discusses more.

insuranceMedical Terms and Codes

CPT and ICD-10 codes are the method MIBs use to describe to insurance companies the diagnosis and treatment that each patient received.

Most healthcare providers only use a fraction of the thousands of available codes, but MIBs must be familiar with the lexicons used by their clients.

Billing software or electronic medical record (EMR) technology is an essential. It’s capable of handling all the coding needs and tasks MIBs will require.

Insurance Idioms

Insurance coverage is available as an individual policy (purchased by individuals) group (provided by employers) and government programs (Medicare, Medicaid, CHIP, CHAMPUS VA, TRICARE and Workers’ Compensation). Each will have its own set of rules dictating what type of services and procedures are covered. Terms to know include:

  • Beneficiary – who is eligible for services;
  • The insured – the primary person who has the policy, making it possible for his/her dependents to receive services;
  • Dependents – a spouse or children;
  • Co-pays and deductibles – costs paid by patients as individuals or as a family;
  • Provider – healthcare professionals, from those who treat clients to facilities that provide medical supplies;
  • Exclusions – services, procedures and treatments that are not covered;
  • Pre-existing condition – a medical condition that existed before the policy took effect;
  • Maximums – the maximum amount an insurance company will pay within a year or lifetime;
  • Pre-approval – services or treatments that must be approved by the payer prior to receiving them;
  • Co-insurance – a second policy that provides medical coverage and shares the cost of an individual’s costs.

Payers and Clearinghouses

Clearinghouses use EMR software to receive reimbursement claims and forward them on to insurance companies for payment. Insurance companies (payers) have a language all their own that’s employed when dealing with practitioners and medical billing professionals. Common terms include:

  • Usual fee – the cost doctors charge for specific services;
  • insurance policyCustomary fees – are based on 90 percent of fees charged within a geographic location;
  • Reasonable fees – is the lesser of what the doctor bills, usual fees, customary fees or a special fee that must be justified;
  • Provider network – is a network of medical providers and facilities that beneficiaries are allowed to see that are covered under their insurance policy.

Numerous educational and certification resources are offered by professional MIB organizations to assist individuals in learning the lingo of the medical insurance billing field. Individuals can find informative books at the library, subscribing to online MIB lists and forums and asking questions, and gain experience through mentoring.

An MIB who can talk the talk with providers and payers will find multiple avenues in which to demonstrate their acumen.
Medical Billing — What Not to Expect When Entering Its World

Medical Billing — What Not to Expect When Entering Its World

Medical billing is experiencing unprecedented growth compared to other professions. A variety of misconceptions and unrealistic expectations have accompanied that development.

In this revealing article, physical therapist and electronic medical record (EMR) specialist, Nitin Chhoda, examines the misconceptions associated with a medical insurance billing business.

medical billing Home-Based Billing

As the demand for medical insurance billers (MIBs) has grown, so has the number of scams promising individuals enormous incomes with no experience needed.

Despite advertisements to be found in multiple media outlets, there is no such thing as a home-based biller.

No medical provider will allow sensitive information to leave the office for someone to toil over like medical billing homework. While there aren’t home-based billers, there are medical insurance businesses that are operated from the biller’s home.


Despite claims to the contrary, a career in medical billing requires specific skills. MIBs must demonstrate a level of competence to become certified that requires a myriad of specialized knowledge. Would-be billers can’t learn as they go and should seek appropriate educational venues.

MIBs will need a working knowledge of ICD-10 and CPT codes, anatomy, clearinghouses, and both commercial and government-funded insurance programs.

Short Hours, Big Pay

Medical billing isn’t a way to get rich quick. Don’t expect to make $40 an hour or $50,000 in the first year. Those claims are the tools used by scammers. MIBs typically make $11-$20 an hour, depending on their level of experience. Entrepreneurs should be aware that the company may not make a profit in the first year, or even the second.

Launching a new business is time consuming. Operating a business from home provides individuals with the flexibility to set their own hours, but shepherding a new business to success is time consuming. Fledgling business owners should be prepared to put in a lot of long hours. Medical billing is a year-round job.


Certified medical billing people that choose to go into business for themselves are responsible for every facet of their enterprise and they must be self-starters. There will be no supervisor watching a time clock or conferring assignments. Working at home is convenient, but it can also be distracting. MIBs will need to be organized and learn to manage their time wisely.

More than Numbersmedical billing software

MIBs do more than just type numbers in a form on a computer. They verify information, check for appropriate coding and transmit reimbursement claims.

Medical billing staff also monitors claims that have been paid and those that haven’t, along with posting payments to client accounts and providing friendly reminders for patients with balances due.

Billers shouldn’t expect to sit home alone with their computers. They have to interact with others in person and via phone.

Medical insurance billing is one of the fastest growing career opportunities available and unscrupulous individuals have taken advantage of that to sell impossible dreams and expectations. Anyone who wants to launch a medical billing firm should begin with the necessary education and be willing to put in long hours to grow a respected and reputable business.

MIB Assistant — Hiring Them Right

MIB Assistant — Hiring Them Right

A large majority of medical insurance billers (MIB) start their businesses at home and as the company grows, the MIB often discovers they require an assistant.

However, liking someone isn’t enough upon which to base a working relationship and in this insightful article, Nitin Chhoda examines the criteria billers should employ when seeking an MIB assistant.

MIB assistantThe key to hiring an MIB assistant is having someone with an eye for detail. The lucky candidate will be functioning as an extension of the biller and in many instances will represent the business to the public.

The MIB assistant will need some basic skills and if they’ve never worked in the field, they’ll need to be trained.

Background Checks

MIBs shouldn’t balk at conducting a background check on potential employees. An MIB doesn’t want to discover that their new MIB assistant has a history of white collar crime, computer theft or embezzlement. It’s better to learn as much as possible about the applicant before making a definitive hiring decision.

Prior Employment

Some type of experience in the medical field is an advantage, but not a necessity. Knowledge of computers, data entry or experience with numbers is also helpful. Even if the person has no experience, if they’re trainable and learn quickly, it’s possible to have a competent MIB assistant in just a few weeks.

Electronic medical record (EMR) technology is essential for secure transmittal of reimbursement claims. Few outside the profession will be versed in their use. Many MIBs choose to leave data entry to their MIB assistant and handle the actual submissions themselves. Either way, MIB assistant must be cognizant of HIPAA security standards and thoroughly understand them.

Skill SetsMIB assistant with EMR

Organization, honesty and integrity are critical skills for an MIB assistant. The individual will be required to communicate with clearinghouses, insurers, patients and clients.

A good command of the language, a pleasant demeanor and a courteous manner are essential, as is the ability to be assertive when needed.

An ideal MIB assistant will have initiative, be able to solve problems on his/her own, and know when to bring difficulties to the attention of the MIB.

Accuracy and the ability to communicate through written means are also essential elements. A winning candidate must be detail-oriented, able to take direction and have a personality that complements the MIB. The MIB assistant will be much more than someone who enters data.

The individual will be an extra pair of hands, but they can also become a friend and the primary backup person should the MIB be unavailable.

Acquiring an MIB assistant is a huge step and one that will have a dramatic impact on the medical billing business. The ideal assistant will ease the MIB’s workload or allow the firm to take on more work. They represent the MIB and the company, making it essential that they have the skills to do it well.

MIBs: Costs You’ll Incur When Starting Medical Billing Business Part 2

MIBs: Costs You’ll Incur When Starting Medical Billing Business Part 2

Launching a medical insurance billing enterprise has the advantage of low start-up costs. Medical insurance billers (MIBs) are aware of the major financial outlays, but there are many smaller costs that are often overlooked in the excitement of entrepreneurship. In the conclusion of this two-part series, Nitin Chhoda inventories the smaller costs of doing business.


MIBs work with computers, digital communications and electronic claim submission, but there are still occasions when paper documents are required.

CMS 1500 forms are the only official claim document accepted by Medicare carriers for reimbursements. They’re available in boxes of varying quantities, ranging in price from $35 for 500 to $150 for 5,000.

Need For Speed

High-speed Internet is essential for MIBs. Those living in highly populated areas can obtain high speed service for as little as $25, but speeds are on the low end of the high-speed scale. Expenditures for the highest speeds can top $150 per month depending upon the provider. Installation fees may also be charged.

MIBs working in rural areas aren’t as fortunate in regard to pricing options. Entrepreneurs living in a country setting may have to rely on satellite service for their Internet connection. Low end speeds can be purchased for as little as $50 per month, while power plans can range from $100-$150 per month.

Customers should also be aware that many plans have usage limits. Additional costs for MIBs may be assessed for those who exceed the ISP’s limits. Some companies simply throttle the available speeds for consumers who exceed their usage.

Talk Isn’t Cheap

A dedicated phone line is essential. MIBs will spend a significant amount of time on the phone and a speakerphone is a wise investment. It allows billers to continue to work even if they’re on hold. It’s not possible to answer the phone 24/7 and MIBs will want to invest in a phone system with the ability to record voice messages.

Depending on the provider, an additional line can cost as little as $10 for MIBs, while other companies will view it as a completely “new” phone service at a cost of up to $50. A speaker phone with answering and message capabilities will range from $50-$100. Expect to pay $150 for a cordless model.

Most phone companies offer voice messaging services for a fee of up to $10 per month for those who want more than a simple phone answering machine.

Power Plays

Lost data or a fried hard drive will quickly put MIBs out of business. Invest in an uninterrupted power supply for potential outages and a surge protector. A power surge can permanently damage a machine, as can low voltage. Power protection costs range from $20-$200.

medical insurance billers

An additional cost for the protection of costly equipment and valuable data will be a thumb drive or separate drive to back-up files and information.

A thumb drive will range from $10-$70 depending on its storage space, while a 2 terra byte drive can run up to $500. Electronic medical record (EMR) technology provides regular back-up in the cloud.

The cost of conducting business requires MIBs to plan ahead for every contingency. High-speed Internet, reliable communications and data protection are relatively inexpensive, but the cost is an essential part of the medical billing business and critical for a reliable and reputable firm.