Without the help of a medical biller, healthcare professionals are at risk of falling behind in billing their patients for office visits. Falling behind in billing your patients can mean a loss in total revenue. For this reason, medical billing is an integral part of every medical office. 

When a doctor’s office bills a patient for an office visit, the medical biller has to submit a claim through an insurance company to receive payments for the services rendered. Medical billing doesn’t just include data entry – it takes customer service skills, attention to detail, and expertise in health insurance.

Many doctors don’t have time to take care of medical billing. That’s why every medical office should hire a medical billing company. Medical billing companies are the backbone of every doctor’s office. Medical billers and coders are there to help you get the most revenue you can out of your healthcare practice.

What Does A Medical Biller and Coder Do?

The most commonly asked question is: what exactly does a medical biller and coder do? Does a medical biller and coder do different tasks than just a medical biller? 

In a nutshell, a medical biller does the hard work of dealing with insurance claims. It’s more than likely the average healthcare professional doesn’t have time to deal with calling insurance companies and checking on the status of a claim. Medical Billers are also the ones who follow up with patients that have past due balances on their accounts.

A medical coder uses a coding textbook to code for the type of office visit that occurred. A skilled coder will be able to code quickly with minimal to zero errors. Most reputable medical billing companies will offer both medical billing and coding services.

Medical billers and coders can specifically deal with the ins and outs of healthcare insurance. They have extensive knowledge about insurance that healthcare professionals don’t have the time to learn. 

Why Should I Hire A Medical Biller and Coder?

After dealing with patients all day (and sometimes all night), no healthcare professional wants to sit down at a computer and do a ton of billing work.

To put it simply, when you bring in a medical biller and coder, you’re taking the first step to maximizing your profits as a medical business owner. Not only do billers and coders help you with receiving payments from insurance companies and patients, but they can also give you aging reports to assess how your business is doing financially. 

Medical billing and coders are usually the ones who perform a follow-up call when a patient has an overdue balance on their account. Basically, they deal with everything and anything to do with medical office finances. If anything is not right with your finances, a medical biller and coder will catch it. 

What Qualities Does A Good Medical Biller and Coder Have?

A quality, professional medical biller and coder will have either a certification, a degree, or a combination of the two. There are multiple kinds of medical billing and coding certifications that a potential employee can have – which ones you’ll prefer depends on what skills you are looking for. 

Hiring the right medical biller and coder for your company means hiring someone who has the required education and background to fill the role. 

Common Medical Billing & Coding Certifications

• Certified Professional Coder (CPC)
• Certified Inpatient Coder (CIC)
• Certified Billing and Coding Specialist (CBCS)
• Certified Coding Specialist (CCS)

Checklist for a Good Biller/Coder

• Has a professional degree or certification
• Has relevant experience
• Has references to call upon
• Knows how to use medical practice management software
• Knows all the billing and coding lingo
• Knows how to use the required books (especially if coding)
• Can promptly communicate any issues to the healthcare provider

The Takeaway: Medical Billers Make Office Life Easier

Daily office life should be easy, organized, and as simple as possible for every healthcare employee involved. Work itself is already hard enough so don’t make it harder on yourself as a provider by billing your patients on your own.

It’s not uncommon for healthcare providers to breathe a sigh of relief after deciding to finally hire a medical biller and coder. Unfortunately, many healthcare providers don’t consider hiring a professional biller and coder until they are extremely behind in their billing. 

By contacting a professional medical billing service, there’s no need to continue stressing about how to manage the billing and coding part of every medical office. Medical billers and coders are a profession in high demand and with very good reason. 

Getting reimbursed for behavioral healthcare services can be a struggle.  The complex maze of insurance rules and regulations makes submitting behavioral healthcare billing difficult and frustrating.  This problem results in only approximately 85 percent of claims being paid.  For some, using a billing service can save their businesses.

Billing Rules Explained

Any insurance healthcare billing system is set up to ensure that real claims get paid fully and efficiently while fake or inflated claims are weeded out.  Large group practices usually have a dedicated staff for billing; smaller practices often use third-party billing services. For service providers trying to get paid, figuring out how to comply with those systems is vital to staying in business and running a practice.

Differences from Medical Billing

Behavioral services billing differs from medical billing because the underlying services are so different.  A specific treatment or test is billed at a specific rate in medical settings.  In contrast, in behavioral services, billing applies to therapy, medical management of patients’ illnesses, and psychological testing.  Insurers’ rules set the reimbursable length of a session, how many sessions per week they’ll cover, and usually a maximum number of sessions that will be reimbursed.  These rules do not change based on the client’s need for longer sessions or more of them.

Most of the time, a mental health professional will wait at least 30 days for reimbursement of a submitted claim.  Also, unfortunately, service providers who contract with insurance companies usually cannot bill for the balance remaining after the insurance company pays.  The balance is simply written off.

Clients’ insurance coverage for behavioral care changes frequently.  Service providers should be sure that clients know they should inform the provider of such changes.  Often, however, even the client isn’t aware of changes.  Thus, you as the provider should check your clients’ coverage frequently to see if you need to make changes in your billing practices.  It is better to change your treatment plan than to implement it and find out it won’t be reimbursed.

When considering how to handle your client payments, think about any given insurer’s pre-approval rules and their limits for payments.  Make sure you understand the length of the session they will cover and the number during each billing period and over the life of the illness.  The more you work with given providers, the more likely you are to do things as they like them.

How a Billing Service Can Help

You can avoid many of these headaches by using a behavior healthcare billing service.  They can improve your collection rates of return and get you to nearly 100 percent successful collections.  Services they can offer include:

Tracking patient demographics, onboarding, and insurance verification

It’s not enough just to have patients.  You have to properly bring them on board, know who they are, and make sure they have insurance that covers your services.  A behavioral healthcare billing service can handle this for you, leaving you free to provide services to these new clients.

Managing accounts receivable

Behavioral healthcare billing services let you focus on treatment while they manage your accounts receivable.  As they do billing and receive revenue, the service will discover problems and remedy them before real damage to your practice results.

Obtaining physician credentialing when required

A healthcare billing service can make sure that all of your workers are properly credentialed.  They can also ensure that each service billed was performed and billed by a professional with the appropriate credentials for that service. As you add new professionals to your practice, it’s vital to ascertain that they are properly credentialed to provide those services.

Auditing codes for maximizing revenue

Proper coding is the heart of getting paid in healthcare billing.  When you have a patient in your office, you record the visit or service in the client’s file.  You include an explanation of why you gave that specific service, test, or procedure.  Your healthcare billing service will work from that record to review and document your clinical records to ensure that the file is complete and that they obtain any missing information.  The service will then apply the correct ICD diagnosis and CPT or HCPCS treatment and procedure codes to the patient’s condition and file the claim.  The billing service then compiles this information under a chargemaster capture code that sets the standard prices for services and procedures you provide.

Reporting on revenue collections

Your healthcare billing service can keep you current on the success of your collections by providing periodic reports on revenue collections.  If there are problems with particular insurance companies or patients, these reports will reveal that to you.

In sum, behavioral healthcare billing allows you, the mental healthcare professional, to concentrate on providing behavioral healthcare.  Meanwhile, someone else devotes time and effort to ensure that you are well-paid for doing so.