Medical insurance billers (MIBs) are the lifeline of a well-funded practice and the connecting link between patients, practitioners and insurance companies.
Billers affect the lives of hundreds of people each week and are an essential link in the reimbursement process. They collect payments for clinicians and ensure that insurance companies pay their portion of the costs for their clients’ healthcare expenses.
Medical billers perform a variety of functions, from entering the alpha-numeric ICD-9 and CPT codes that tell insurance companies the treatment a practitioner provided to interacting with patients on the balances they owe.
Medical billing staff works with sensitive data each day that requires confidentiality, integrity and ethics.
First Step — Data Collection
An MIB often functions as a coder and a biller, though the jobs can be exclusive of each other. Medical billers gather all the information associated with a patient’s encounter with their healthcare professional.
That information provides the documentation that will be used to support the payment requested from insurance carriers.
They decipher the data to determine the patient’s complaint and the appropriate CPT code to reflect the treatment provided.
Medical Billers Should Have Good Communication Skills
Medical billers spend a considerable amount of time interacting with others as part of the data collection and payment process. Clinicians must be queried to clarify patient encounter information and patients contacted about their payment obligations.
Medical billers also interact with insurance company representatives on reimbursement issues.
MIBs Must Always Verify the Facts
Medical billers are responsible for verifying patient insurance information, the correct billing format for each payer, and assigning the codes and modifiers that result in the practitioner’s payments.
They work with hard facts about patient policies, physician services and insurance company protocols.
Medical billers may also transcribe a doctor’s dictation about the patient encounter. Billers are knowledgeable in medical terminology, which helps them in assigning diagnosis and procedure codes.
Medical Billers Must Have Computers and Integrated Software
Medical billers spend a majority of their time behind a computer screen, ascertaining the facts of each patient encounter. They work with specialized billing software, like In Touch Biller Pro,or electronic medical record (EMR) systems, like In Touch EMR, that assist them in coding correctly, meeting the many submission demands made by payers, and transmitting claims electronically.
Consistent in Following Up Funds
They submit claims to clearinghouses where they’re examined for mistakes, errors and inconsistencies.
Clean claims are forwarded on to payers for reimbursement.
Medical billers track and monitor each claim to determine its status, ensure payments are made in a timely manner, and deposited in the practitioner’s account.
They work with clearinghouses and carriers if a claim is denied to obtain payment, and interact with patients on co-pays, deductibles and balances owed.
IMPORTANT: Medical billers ultimate responsibility is to ensure that clinicians collect the maximum amount of money to which they’re entitled.
Medical billers wear many hats in their profession. They’re often one of the first and last individuals with which patients interact on financial obligations, and they comprise the key element in the reimbursement chain.