Being a medical biller and collector takes a lot of patience and dedication. As a medical biller and collector on one has a lot of responsibilities in the medical practice. One must make sure that doctor charges are posted and claims are submitted to the correct Insurance in a timely manner. Check claim status. Appeal claims that are denied. Post payments and proper adjustments. Mail out patient statements and make collection calls.
At the end of every day I have to make sure that all medical charges are posted into the computer system. Once the charges have been posted then I submit all the medical claims to the correct insurance carrier. My job is to make sure all claims go thru the clearing house without error. This means all claims must be clean claims. If there is an error on any of the claims being submitted, the clearing house will reject the claim and it’s my job to correct the error and resubmit the claim. I run a daily aging report which gives me a list of all the outstanding claims still pending insurance payment. I then call the insurance to check on the claim(s) status to make sure the claim was received and in process. If the claim was not received that my job is to resubmit the claim to the insurance carrier. If the claim was received and in process, then I need to wait at least 15 to 20 days for the claim to be either paid or denied. There will be claims that will be denied by the insurance carriers for some reason or another. I is my job to call the insurance and find out why the claim was denied. A claim could be denied for any reason from the claim being submitted with the wrong patients date of birth, wrong procedure code, service not authorized or not covered, etc. Once I know why the claim was denied, then I could resubmit the claim with a written appeal, stating why services should be reconsidered for payment, resubmit a corrected claim with the correct information being requested. If payment is received with the explanation of benefits or remittance report from the insurance carrier, it will indicate how much was paid to the provider of service, how much needs to be adjusted off and the amount the patient is responsible for (owes the doctor). …show more content…
After I posted the payment, adjustments, I generate a bill or statement, indicating the about due by patient (according to the insurance) and mailed to the patient. After three statements sent to the patient no payment is received, then I make a courtesy call to the patient to make an attempt to collect any balance due prior to me sending it to collections department. This is where your “patience” come in play as a medical biller and collector. Many patients will not be happy to receive a medical bill. This is because many of them think that the only money the owe the provider of service is their copayment. They really don’t understand their insurance coverage, especially the elderly. So, I take the time to call the patients insurance and find out what the benefits are and then explain the benefits to him or her, this way he or she could understand why there is an additional payment due to the provider other than the copayment amount. I believe this is an important step that all billers and collector should do, help the patient understand his or her benefits. I know of billers and collectors that work for a billing company and doctors offices that don’t take this extra step, they claim it is not their job. I believe that it is part of our job. Then you have the patient’s that know what their insurance benefits are and don’t have a problem paying any additional balance due. I do come across a few patients that a going through some financial hardship and ask to be put on a monthly payment plan and we do. And we also have those patients that totally refuse to pay and don’t care to be sent to a collection agency because their credit is already ruin anyway. Attending Southwest University, I have met many students studying and going after that associates degree for medical coding and billing. Listening
At the end of every day I have to make sure that all medical charges are posted into the computer system. Once the charges have been posted then I submit all the medical claims to the correct insurance carrier. My job is to make sure all claims go thru the clearing house without error. This means all claims must be clean claims. If there is an error on any of the claims being submitted, the clearing house will reject the claim and it’s my job to correct the error and resubmit the claim. I run a daily aging report which gives me a list of all the outstanding claims still pending insurance payment. I then call the insurance to check on the claim(s) status to make sure the claim was received and in process. If the claim was not received that my job is to resubmit the claim to the insurance carrier. If the claim was received and in process, then I need to wait at least 15 to 20 days for the claim to be either paid or denied. There will be claims that will be denied by the insurance carriers for some reason or another. I is my job to call the insurance and find out why the claim was denied. A claim could be denied for any reason from the claim being submitted with the wrong patients date of birth, wrong procedure code, service not authorized or not covered, etc. Once I know why the claim was denied, then I could resubmit the claim with a written appeal, stating why services should be reconsidered for payment, resubmit a corrected claim with the correct information being requested. If payment is received with the explanation of benefits or remittance report from the insurance carrier, it will indicate how much was paid to the provider of service, how much needs to be adjusted off and the amount the patient is responsible for (owes the doctor). …show more content…
After I posted the payment, adjustments, I generate a bill or statement, indicating the about due by patient (according to the insurance) and mailed to the patient. After three statements sent to the patient no payment is received, then I make a courtesy call to the patient to make an attempt to collect any balance due prior to me sending it to collections department. This is where your “patience” come in play as a medical biller and collector. Many patients will not be happy to receive a medical bill. This is because many of them think that the only money the owe the provider of service is their copayment. They really don’t understand their insurance coverage, especially the elderly. So, I take the time to call the patients insurance and find out what the benefits are and then explain the benefits to him or her, this way he or she could understand why there is an additional payment due to the provider other than the copayment amount. I believe this is an important step that all billers and collector should do, help the patient understand his or her benefits. I know of billers and collectors that work for a billing company and doctors offices that don’t take this extra step, they claim it is not their job. I believe that it is part of our job. Then you have the patient’s that know what their insurance benefits are and don’t have a problem paying any additional balance due. I do come across a few patients that a going through some financial hardship and ask to be put on a monthly payment plan and we do. And we also have those patients that totally refuse to pay and don’t care to be sent to a collection agency because their credit is already ruin anyway. Attending Southwest University, I have met many students studying and going after that associates degree for medical coding and billing. Listening