What You Should Know About A Medical Billing Specialist

Whether you are a person who is thinking about becoming a medical billing specialist or a company looking for a medical billing specialist, then this article is for you. There are several things that you should be aware of in the medical billing industry and I will walk you through them so that you will have the background information that you need to help you make a decision that will best suit your needs. We will first take a look at what it takes to become a medical billing specialist, and then we will also explore the alternatives to hiring a medical billing specialist.

What is a Medical Billing Specialist?

A medical billing specialist is someone who works with a medical office and is in charge of the company’s medical billing. If you desire to be a medical billing specialist then accuracy and attention to detail is a must as you will most likely be in charge of claims processing, charge entry, and billing and collections. However, most medical offices will hire someone to do more than just be in charge of medical collections. They will want someone to be more of a medical assistant as well. Job duties will then expand to include things like:

o Accounts payable, payroll and banking tasks

o Prepare and maintain patient charts

o Schedule appointments

o Receive and make phone calls

o Perform insurance verification, pre-authorize and referral duties

How do I become a Medical Billing Specialist?

Most businesses will require you to either have several years of experience working as a medical assistant or some kind of advanced certification as a medical assistant. There are several programs out there to help train and educate you to become a medical billing specialist. By doing a Google search for “medical billing specialist” you should be presented with a lot of options to help guide you to becoming a certified medical billing specialist. There are programs that you can complete online and at your own pace. Others require you to attend some classes for a couple of semesters. In my search I found many of the programs to cost around $1000 but some were as much as $6500.

Is it worth it to become a medical billing specialist?

The medical industry is experiencing a tremendous demand for individuals knowledgeable in medical office operations. Medical billing specialists are one of the fastest growing professions and are currently a very high demand job. According to the American Medical Association, there are over 1.2 million Medical Specialists in the United States. If you are interested in this kind of profession, it would be to your advantage to learn more about it.

What about outsourcing?

Because of the time and meticulous accuracy that medical billing requires, there are some companies that only specialize in being a medical billing specialist. Medical offices outsource all of their medical billing practices out to these companies rather than hiring an in-house specialist to manage their medical billing needs.

Is there software that can do everything a Medical Billing Specialist can do?

There is yet another solution to managing your medical billing needs. Companies such as AdvancedMD provide a software solution to be your medical billing specialist. An advantage for a medical office to go this route might be that it will be cheaper in the long run to have software to manage all of their billing needs. Also the electronic medical billing specialist will be less prone to errors unless they are due to a human entry error.

As you can see there are many solutions to help you to better manage your medical office. There are advantages in every category; it just depends on what will be the best fit your office. If you are thinking about becoming a medical billing specialist, I feel that it is worth looking into as it is a very high demand job. However, you should be aware that with alternatives out there, like outsourcing and medical billing software, you might have a little competition.

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Medical Billing Services Save Heatlhcare Practices Money and Time

There are many reasons healthcare practices might outsource their billing to a professional medical billing service; confusing insurance requirements, staffing problems and just keeping up with industry changes are a few examples. In the end though, the reasons most medical billing companies hear about come down to the two driving principles of any business – Time and Money. This article discusses how medical billing services are able to create significant savings in time and money for healthcare providers.

Medical Billing Services Save Training and Research Time
- Some readers might take the short view and think medical billing companies just enter data into a computer and send it off to a clearinghouse. In reality medical billing is a detailed process requiring specialized skills and in-depth knowledge of medical practice management, insurance industry practices, and the regulatory framework around state and federal laws. Professional medical billing companies invest countless hours in training and research to keep abreast of current codes, submission requirements, industry trends and the needs of their clients.

Significant expenditures are also made to ensure medical billing companies are up to date on the latest software. In a constantly changing industry, software vendors are always finding new and better ways of supporting practice needs. It’s not practicable for small or medium sized practices to dedicate the time necessary to stay on top of the latest innovations.

These investments of time by professional medical billing services are often not considered by providers, but they eliminate endless hours otherwise spent in seminars, meetings with vendors, or on the phone with clearinghouses and carriers. This time savings creates a valuable commodity for a practice seeking the edge necessary to keep up with a rigorous patient schedule.

Medical Billing Services Save Operational Time
-Medical billing services are able to save operational time by leveraging the economy of scale and the efficiency of task specialization.

Professional medical billing companies, by their very nature, create an economy of scale in maintaining a team of medical billing professionals to provide services across several practices. This structure creates a well trained pool of resources to manage each practice’s needs rather than just one individual overseeing all billing functions. The team approach also removes interruptions to revenue flow that result from vacations, unexpected sick time and staff turnover.

Task specialization among teams further heightens the efficiency of medical billing companies. Through task specialization, a team of billers can accentuates individual skills and reduces distractions of other activities.

Consider a provider who sees an average of 30 patients per day, or a total of 150 encounters per week. The time required to generate and submit 150 patient claims and follow up with insurance carriers with a high lever of accuracy can take up most of the time of an in-house biller. But this is just the beginning. That same individual will also need to follow up on denied or partially paid claims, researching why and resubmitting for further review. Patient invoices require additional time- printing, stuffing and mailing- as well as posting payments, running reports and providing detailed analysis on the current state of the practice; all this just to meet the standard offering of professional medical billing companies.

Through task specialization, medical billing companies might offer each of its clients several billers submitting claims and reviewing insurance payments with the highest level of accuracy. At the same time, the service might have other individuals or groups dedicated to managing patient invoices and questions across several practices with increased efficiency. This approach maximizes the time available for each activity by specialists with a greater knowledge of their roles, and, again, guarantees minimal (if any) interruption during employee leave and staff changes.

Medical Billing Services Save Money
-Hiring and training new staff, employee benefits, vacation/sick leave, and staff turnover are just a few factors increasing the costs of managing an efficient in-house billing program. Added to the operational overhead of day to day billing, software/hardware maintenance, clearinghouse fees, postage, and so on, the list of expenditures for practices is endless.

Good medical billing companies will design their services around covering all of these costs and immediately do away with the problems they create. To clearly demonstrate how medical billing services can save practices money, let’s compare the core costs associated with in-house medical billing against working with a professional medical billing service.

Cost of In-House Billing:
Our comparison begins with a typical practice with one or two providers. Let’s assume this practice has a dedicated, in-house biller receiving an annual salary of $30,000, or about $14.50 per hour. The chart below outlines the additional costs of having a full time employee in the office to handle all aspects of medical billing.

Base Pay ————————–$30,000
Medicare and Social Security ———$2295
401K ——————————–$1080
Disability —————————–$720
Healthcare ————————–$5220
Time off —————————–$3270
Total labor for 1 in-house biller ——$42,585
Next, we’ll need to consider materials and fees. An average practice will probably upgrade computers and software every 3 years at a cost of about $6,000. Spread out over those three years, we’ll assume an average annual software/hardware expenditure of $2000. Since our practice will send out its own patient statements, we’ll need about $150 per month for postage, paper and envelopes, an annual cost of $1800. Clearinghouse fees for electronic claims will come to about $60 a month, or around $720 annually. For the sake of simplicity, we’ll forget for the moment that our biller will need a climate controlled workspace, lights, general office supplies and a desk.
Here’s what our list of software/hardware, materials and fees looks like:

Software/Hardware —————–$2000
Materials —————————$1800
Clearinghouse Fees ——————$720
Total ——————————$4520
Adding the two totals above (labor + materials & fees), the annual cost of medical billing services performed in-house by the practice comes to $47,105 per year. Of course this number might not mean much until we put it in perspective against teaming with a professional medical billing service. As we move forward, keep in mind this conservative estimate does not factor in those other costs mentioned above that are often hidden – ongoing training, unexpected leave and sudden staff changes.
Cost of Professional Medical Billing Services:
To evaluate the cost of working with medical billing services, we’ll assume our practice has contracted with a medical billing company for full service billing. This includes all of those activities that would otherwise have been performed by the in-house staff above; claim generation/submission, insurance follow up, patient invoicing and support, detailed reporting, expert practice analysis, etc. We’ll also assume the practice has negotiated a rate of 8% of collections with its professional medical billing service.

Note: Calculating costs for medical billing services will vary slightly depending on the fee structure but will usually be based on either a percentage of collections or a fixed fee per claim. For more information on fee structures, see Percentage vs. Flat Fee Pricing by Medical Billing Services.

Assuming our provider visits 30 patients per day, 50 weeks out of the year, we’ll have 7500 patient encounters per year. If each encounter results in an average reimbursement of $60, our receivables come to a little over $450,000 per year. At a rate of 8%, the annual cost for the professional service to manage all aspects of medical billing services for the practice would be $31,500. In comparison with in-house services that’s a savings of $15,600 per year!

In evaluating the benefits of outsourcing to a professional medical billing company practices should consider the overall savings in time and money, beyond just minimizing the hassles. Medical billing companies provide knowledge, training, continuity of operations and a network of support leveraging task specialization and the economy of scale. Medical billing companies are able to eliminate dependency on one or two costly staff members to maintain revenue flow for the entire practice.

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