The Medical Billing Industry

I get asked frequently:  How did you get into Medical Billing?  Can I get started without any experience?  Is it true you can make lots of money at this?  Do you think it is something I can do?  Is it true you can do this from home?  If these are questions you have had, I hope this article will help answer them for you.

As of the date of this article, I have 15 years experience in the Medical Billing industry and I answer the question about how I got into the field here.  You can get started without experience, just as I did, but without experience you will have a hard time convincing a physician or practice manager that you know what you are talking about and that they should entrust you with such a substantial part of an impact to their practice, remember you are dealing with the cash-flow of their business.  A physician is going to want to see that you have a history of experience, knowledge pertinent to their specialty and an ability to collect on their claims.  I would recommend anyone wanting to get into the Medical Billing industry obtain a position working in the medical field directly with someone who has this knowledge and begin learning the industry in a hands on method.  This process is critical for success as to learn all this on your own without anyone that has the expertise needed would make a challenging career even more challenging, and a lot of mistakes would be made by trial and error that can be avoided!  

The health insurance industry and medical billing industry go hand-in-hand and are ever-changing. Federal and State regulations are continuously changing and unless you are prepared to continue education and stay up on the rules you will only be frustrated by the results of your efforts.  This is not a field you learn the basics and don’t have to continue to learn the industry.  Education and knowledge are one of the main keys, if you are willing to invest the time in learning the industry, understand that there are very strict regulations, have a growing commitment to continued education, have an aptitude for attention to detail, comprehend the requirements and need for accuracy, know you will need to fight to get things resolved and not sit back and wait for the process to happen, then you will be an excellent Medical Biller and you can be very successful. In order to be successful in an overwhelmed industry with a greater need then was there say 10 years ago for medical billing, you have to educate providers on all the benefits of outsourcing on top of marketing your education and/or experience.  The term medical billing is very generic because the title doesn’t convey all that is involved.  To be an excellent Medical Biller you will have to have strong knowledge of financial concepts and accounting principles, be well-organized, detail oriented, efficient, accurate, strong analytical skills, ability to multi-task, willing to fight for your rights, understand all rules and regulations (including but not limited to federal, state, provider, insurance carrier, etc), understand the importance of follow-up and promptness, ability to explain to both the physician and the patient every aspect regarding their benefits and the way a claim was processed, etc.  The process of medical billing involves everything from benefit verification to claims follow-up, appeals, payment posting, recoupments, refunds, overpayments, patient billing, providing your client with precise and accurate statistical reports on the health of their practice, etc.  Basically you are following every claim from beginning to end to create a zero balance, this sounds easier said than done. Let’s look at the various elements of what you need to provide your client with these services:

  • Understand the CPT, HCPCS, and ICD9 Rules and Regulations
  • Understand and identify Modifiers and their various uses
  • Understand the importance of verifying and understanding patient’s benefits
  • Understand the importance of obtaining and understanding managed care authorizations and coverage limitations
  • Understand the various types of insurance plans available and being able to differentiate each plan and how they are constructed (HMO, PPO, Indemnity, POS, Workers Compensation)
  • Understand the insurance contracts for you provider
  • Understanding government payers as well as federal and state regulations
  • Understanding the CMS HCFA1500 form and UB92 form
  • Understand each element of the electronic claims filing process
  • Understanding the HIPAA Regulations (Health Insurance Portability and Accountability Act) and adhering to the rules
  • Understanding the importance of compliance as well as policies and procedures
  • Understand the importance of continued education, both on-line or in-class (seminars, association memberships, insurance bulletins, etc)

Many advertisers market Medical Billing as someone who just files insurance claims and makes a lot of money doing so from home.  Yes, you can do medical billing from home, but it isn’t something you just push a button and it happens, it does take a skilled person to be involved in the process, it is not 100% automated.  Can money be made at Medical Billing?  Yes.  Is it lucrative?  No.  Just like any other industry out there, greater money is made by hard work and effort, it is not a get rich quick scheme.  If you want to make good money, you are going to have to work very hard to do so.  It is a rewarding industry if you put the time and effort into learning it.


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