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.
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!
Summary
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.
It’s not news nowadays that healthcare providers are heavily outsourcing their medical billing services to professional companies to look after their medical billing and collections. A number of physicians, hospitals, nursing homes, urgent care centres, laboratories, DME companies, and other entities associated with the healthcare industry have realized the need for professional handling to regain focus on revenue recovery mainly through the reduction in operational costs.
There lies another challenge ahead – to find out the proper medical billing service, which can provide you with the solution you are looking at your budget. It is extremely important to research rigorously by self-defined parameters for selecting the desired service. However, some common factors that can be broadly considered essential for most healthcare providers can be discussed:
Points to Ponder
Some basic points that cannot be overlooked in your search for the desired medical billing assistance will include the following:
• Accurate and efficient service: Go for the medical billing services that can take the onus of all your billing collections – accurate, complete, and timely payment from the third party payers and patients through latest technology to attain maximum efficiency in the system.
• Excellent references: Revenue is the key focus and you need more business for that and for more business you need more references. Look for medical billing services that have enough experience and reputation to provide you excellent referrals from physicians.
• Expert coding: Coding is one of the most important aspects of medical billing in this time of EMR and EHR technology. Sought medical billing services that can provide you with the required expertise in ICD-10 coding. Due to an absence of certified and experienced coders in their in-house team, most of the practices suffer from common coding issues like:
o Unbundling: Unbundling involves listing of different billing codes for charging for services falling under one billing code. This results in bill getting inflated because the items that should have been billed as a package rate get billed separately.
o Balance billing: This coding error arises when the balance bill sent to the patient after the insurance company’s price negotiation with the care provider and all of the hospital’s charges are supposed to be covered under the patient’s policy.
o Duplicate Billing: Another common billing error, which involves multiple bills getting generated for the same procedures or services.
• Dedicated account management: Always prefer a service that provides you, experts, to dedicatedly look after your collections without any extra charge. The account managers should always be within your communication range to provide assistance during an emergency.
• Flexible services: Sometimes you might need a single service like prior authorization. Choose a medical billing service that can offer you standalone services as and when required and not charge for a whole package for RCM or other packages. It should also be flexible enough to work in both the electronic and manual platforms as per the requirement.
• Special edge: A great and a good medical billing service can be distinguished by the virtue of that ‘something special’ it offers. A great medical billing service can maintain a seamless healthcare management through cutting-edge services for the patients, providing your practice with the professional guidance it needs to complete a comprehensive end-to-end revenue cycle management. An experienced and reliable company can do the trick for you by achieving the seamless overall transitions from your time and cash stripped condition to making your practice revenue-healthy, up, and running.
Errors, both electronic and human can nag your practice from getting the desired result. Signing a really able medical billing service will provide you with the shield from those errors saving you unnecessary loss of time and money!
Many health care professionals love working in medical billing and coding. The medical billing career field allows professionals the flexibility to work at home or in a medical facility. And training to become a medical billing professional can usually take less than a year.
The medical billing career field isn’t for everyone; it requires patience, flexibility, and analytical skills to use proper medical codes and bill insurance companies correctly. And it’s a career field for people who want to work in the medical field, but would prefer to work in the administrative side, rather than in the clinical side with patients.
If the medical billing career fields sounds interesting to you, then check out the top ten reasons to work in medical billing and coding.
1. HOT EMPLOYMENT GROWTH FOR MEDICAL BILLING INDUSTRY As you probably know, the medical billing and coding field continues to increase due to a growing need for medical procedures needed by our aging population. Every medical service requires medical billing professionals to relay procedure and cost information to health care insurance companies.
The U.S. Department of Labor recently reported that 8 out of 20 occupations projected to grow fastest are in the health care industry. They also projected that careers in the medical records and health information technician industry should increase 27% or more for all occupations through 2014.
The rise in employment opportunities is great news for trained medical billing professionals. It means that trained medical billing professionals should have job security and lot of job growth going forward.
2. SHORT-TERM TRAINING TO WORK IN MEDICAL BILLING AND CODING Another great reason you should consider starting a career in medical billing and coding is because of the short-term training.
Depending on the school you attend, you can graduate with a diploma in medical billing within a year, and you can get an Associate’s degree in medical insurance billing and coding within two years.
The short-term medical billing program often includes a study of:
Medical Insurance & Billing Issues
Medical Documentation and Evaluation
Government Health Care Programs
Electronic Data Interchange
Medical Insurance Claim Form (CMS-1500)
Ethical and Legal Responsibilities
The Associate’s degree medical billing programs often include a study of:
Medical Terminology
Medical Office Management
ICD-9 Coding
Advanced Medical Coding
Medical Billing and Coding Computer Applications
Due to the short-term training, many medical billing schools offer day and evening classes. Please be aware that not all schools offering medical insurance billing and coding will be right for you. Before choosing a school, make sure and read the article on choosing a high quality medical billing and coding school.
3. MEDICAL BILLING CAREERS CAN ALLOW YOU TO WORK AT HOME Many doctor’s offices and clinics don’t handle their own medical billing. They will often hire an outside medical billing agency or medical billing company. Some of these agencies and medical billing companies will hire professional medical billers who work at home to save on costs. And this is definitely an option if you decide on a career in medical billing.
It’s recommended that if you decide to work at home as a medical billing professional, or decide to work as a self-employed medical biller, that you work in an office as a medical biller for a short period of time so that you will gain the confidence and skills of a seasoned medical biller.
4. MEDICAL BILLERS HAVE MANY CAREER OPTIONS Professional medical billers have a solid knowledge of the administrative side of a medical office. Depending on their education and experience, medical billers can move into:
Medical Billing Management
Medical Transcription
Health Care Administration
Data Collection
Medical Office Management
Health Information Technician
And this is just a small list of possible career paths for seasoned medical billing professionals. These jobs will depend on your education, experience, and job market in your local area.
5. MEDICAL BILLERS CAN START THEIR OWN COMPANY Due to the high demand for medical billing professionals, some medical billers are deciding to leave their medical billing job to start their own medical billing company. This is only recommended for seasoned medical billing professionals who can find an assortment of medical offices that can become clients.