What Does A Medical Biller Do All Day?

A Day In The Life Of A Medical Biller

A normal day in the life of a Medical Biller does not very too much. An experienced professional will generally complete tasks in the same series of areas each day as they pertain to patient billing and contact with insurance companies, health care agencies such as Medicare and Medicaid and even collection agencies. A Medical Biller’s workday will generally include, but is not necessarily limited to, many of the following areas:

  • Medical Billing Statement Organization
  • Billing Review & Quality Control (To avoid any errors or omissions)
  • Insurance Agency Claims Negotiations
  • Collection Agency Claims Negotiations
  • Patient Question & Answer Communication
  • Coordination with Medical Coders
  • Continuing Education Regarding Industry Standards

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Each time a medical professional such as a doctor, dentist, nurse or technician sees a patient, a service is provided that must be billed for. The service provider will report what was provided to the patient to the Medical Coder. This service will be coded using the industry guidelines used by all medical facilities and then passed on to the Medical Biller. This professional is then responsible for turning this coded report into a proper bill that can be mailed to the patient’s insurance agency, Medical or Medicaid or the patient himself or herself.

It is very important that this bill is clear, concise and free of any errors or omissions. A Medical Biller must analyze each claim for mistakes in order to properly negotiate payment with the party responsible for each claim. If there are mistakes, the entire process can be put on hold, causing a great deal of trouble for not only the patient but also the doctor or health care provider who performed the service.

The next step of a claim is to negotiate this claim with the insurance company, government agency or patient. A bill with errors makes this process much more difficult. A Medical Biller may spend a great deal of time on the phone speaking with responsible payment parties, depending on what types of claims they are responsible for preparing. For instance, a Medical Biller working for a doctor such as a general family practice doctor performing mainly physicals, who does a generally straight forward service for a large number of clients who are treated in much the exact same way may have a much simpler time as negotiations for claims do not vary much between patients. However, a doctor such as an infectious disease specialist may a large number of non-routine, independent cases. For this reason, each claim may vary a great deal from the one before. A Medical Biller working for this physician may very well spend a great deal more time on the phone negotiating claims that the professional we previously discussed.

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Assignment of Benefits (AOB)

There are a number of categories within Medical Billing that a professional must learn and function within each day. An Assignment of Benefits, or AOB, is the act of assigning the cost of medical care to the correct party as indicated by the contracts of the patient’s health insurance coverage, whether that be a public or private agency, or even whether that individual has decided to pay for the claim themselves. There are a number of types of claims including inpatient and outpatient medical, global and minor surgery and follow-ups. The Medical Biller is responsible for setting up a file for each patient and maintaining this file within that office. Each health insurance company may view these claims a bit differently, so the Medical Biller must be well versed with each company’s procedure.

Likewise, knowledge of Medicare and Medicaid procedures are important. A claim must first be determined to be eligible for one of the areas within these entitlement programs, also depending on whether it is a state or federal issue and whether preauthorization was given. A fee schedule must be adhered to, and any supplemental plan information must be factored in. Knowledge of claim forms such as HCFA 1500s are important. TRICARE plans are slightly similar, although they cover different groups of patients. This is healthcare for military personnel, veterans and their families.

Areas that are addressed on a regular basis, depending on the type of patients seen, can include a number of different agencies:

  • Health Insurance Agencies
  • Medicare / Medicaid
  • Tricare (Military Benefits)
  • Workers’ Compensation Plans
  • Direct Patient Billing

Once all bills have been reviewed for correct content, entered into the account database and mailed out to their respective billing party, a Medical Biller is still not done. They must follow up on these payments and post them when they are received by the office or facility where the service was provided. Medical Billers are the ones responsible for following up with both unpaid insurance claims as well as individuals who have not paid either their portion of the bill, co-pay or any other fee for which they have assumed responsibility. Should an agency deny a certain claim, it is up to the Medical Biller to negotiate on behalf of the office or physician to settle on the correct payment. Lastly, this person will put together the information necessary to report on the financial status of the medical care provider’s business on a regular basis.