How to Be Successful in Medical Billing

Here are 5 areas that require an understanding in order to be successful in medical billing.


Understanding the Revenue Cycle

Patients waiting for an appointment.

Understanding the entire revenue cycle is crucial for medical billing. Each part of a medical claim represents the information that is collected from the time the patient schedules an appointment until the patient receives services. Each phase of the revenue cycle — from the moment a patient is scheduled for an appointment until the time payment is received from the insurance company — is equally important to maximizing insurance reimbursements.


Understanding Insurance Companies

Health care reimbursement
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There are thousands of insurance companies for the medical office to file their medical claims to. Although the majority of insurance payers follow the standard billing guidelines for most of the information you see on a medical billing claim form, there are certain aspects of medical billing that is payer-specific. In order to submit medical claims efficiently, medical billers need to know or have access to lots of information for each insurance company.

  • Billing methods - electronic and/or paper
  • Timely filing requirements
  • Corrected claims
  • Refunds
  • Appeals
  • Contact information

Medicare is another type of ​payer that is unique to other insurance companies. Medicare billing does not have to result in lots of rejections and denials if you have the proper knowledge of Medicare billing guidelines. It is important to understand Medicare billing requirements which can be somewhat complex. Consider attending training events and opportunities. Providers must ensure that those responsible for preparing and submitting claims to Medicare are aware of proper submission guidelines and regulations.


Understanding Coordination of Benefits

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Coordination of benefits (COB) is a term used when a patient has two or more health insurance plans. Certain rules apply to determine which health insurance plan pays primary (first), secondary (second) or tertiary (third). Understanding COB means understanding how to bill claims in the correct order to prevent a delay in payment.


Understanding Medical Billing Software

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Getting your medical claims out of the door and paid as soon as possible is every health care provider's primary goal as far as finance is concerned. The faster the claim goes out, the faster the money comes in. Billing software has transformed how the medical office files medical claims by improving productivity and quality. Familiarity with the type of billing software being used will save time, minimize errors, and prevent a lot of headache. Take advantage of the training that software providers offer and if necessary, contact them as necessary when issues arise.


Understanding HIPAA Privacy & Security

protected health information
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Any organization that accesses patient health information is considered a covered entity and is required by law to comply with HIPAA provisions or face civil and/or criminal penalties. Medical billing staff has access to private, confidential patient health information and must be informed of ways to avoid violating HIPAA privacy and security rules.

Here are 4 ways medical billers can avoid violating HIPAA:

  1. Routine Conversation. Healthcare professionals should be very careful to refrain from disclosing information through routine conversation. This can easily be done by mentioning to a third party something seemingly insignificant as saying that John Smith had an office visit today.
  2. Public Areas. Discussing patient information in waiting areas, hallways or elevators should be strictly off limits. Sensitive information can be overheard by visitors or other patients. Also be sure to keep patient records out of areas that are accessible to the public.
  3. Trash. PHI should never be disposed of in the trash can. Any document thrown in the trash is open to the public and therefore a breach of information.
  4. Gossip. Gossip is particularly hard to control. That is why it is important that access to information be strictly limited to employees whose jobs require that information. This type of violation can be particularly damaging to the reputation of your organization especially in small communities where "everybody knows everybody."
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