Work Area Challenges Faced by a Medical Biller and Coder

While the scope of medical billing and coding profession is extensive ranging from handling erratic patient calls to filing proper claims to insurance industries to billing accurately to ensure that the medical practitioner gets proper returns for his services rendered; learn about the on field challenges faced by a medical biller.

Out of extensive list of duties supposed to be carried out by a medical biller as the scope of their work, two most important challenges faced by a medical biller are described below:

Claim processing Requirements:

The main scope of work in the field of medical billing and coding includes appropriate filling of claims to the insurance industries to ensure that the medical practitioner is paid appropriately for his services and also ensure that the whole process of filling claim and resubmitting the same in case of denial form the insurance industry is undertaken smoothly and benefits his clients.

Dealing with Patients and Insurance Firms:

It is a part and parcel of medical biller’s duties to deal directly with the patient’s calls with respect to medical billing and medical statements. Such situations demand high skills is communicating effectively with people and making their point softly yet sternly to the opposite party. The same discretion will be required when dealing with insurance company officials in case of disagreement between the medical biller and the insurance firm regarding the claim amount. It is believed that the way a medical biller deals with patients over the phone regarding issues such explaining charges, dealing with erratic patient queries regarding medical billing will decide whether the patient will come back to the doctor again or not!

Below given is a simple step by step flow chart to be followed by any medical biller to carry out his day to day claim filing procedures:

•Enter the patient’s name and other details along with details of new insurance carriers if any to the existing database.

•Enter any referral source of physician’s name and other similar information.

•Go through the superbills and day sheets and accordingly enter the CPT and ICD-9 codes. These codes will automatically fill in the amount charged for each and every medical procedure.

•Transmit the electronic claims directly to the clearing houses or the insurance industries and correct any errors in it if any on receiving the audit report for the same.

•Forward the clean claims further and resubmit the rejected claims.

•Print the paper claims and post payments carefully to each patient’s account.

•Keep a track of aging reports of patients and keep a track of those who haven’t been paid timely.

Check on if any of the claims have delinquent and follow up regularly with the status of filed claims.