7 Things Every Medical Biller Should Know

1.       Rules & Regulations

Have an understanding of the rules and regulations set forth by each and every entity: 

  • Centers for Medicare & Medicaid Services (CMS)
  • American Medical Association (AMA)
  • Health Insurance Portability and Accountability Act (HIPAA)
  • Office of Inspector General (OIG)
  •  State Laws (per your state) – a resources for Texas:  Texas Department of Insurance (TDI), Texas Medical Board (TMB), Texas Medical Association (TMA), and Tarrant County Medical Society (TCMS)
  • US Department of Health and Human Services (HHS)
  • The Fair Debt Collection Practices Act (FDCPA)
  • Protected Health Information (PHI)
  • Insurance Payers specifications & regulations
  • Prompt Pay Act



2.       Obtain Copies of your Insurance Contracts

The importance of having copies of your contracts with the payer’s is so that you are aware of the physician’s legal obligations, agreed upon terms, and defined requirements to ensure that you adhere to their specific regulations.  It also defines other pieces of information that are helpful to you in dealing with medical claims.


3.       Make a list of your top 10 or 20 CPT Codes

This enables you to already have prepared your top codes when either an insurance company requests it or to submit to an insurance company to obtain their contract rates if you don’t otherwise have them.  Make sure that this procedure code list is current and up-to-date.


4.       Medical Terminology

Be familiar with the medical terminology of your field or practice specialty.  Research all the information available regarding the specific specialty of your practice.  This will provide you with an extensive amount of resources, knowledge at knowing the when, where, why & how’s for treatment, testing, medication, etc.  This will be a benefit to your advantage when you are trying to explain details and/or resolve issues with either insurance companies, patients or other entities.


5.       The Importance of Accuracy

Accuracy and attention to detail are key aspects of a medical biller’s success.  Accuracy affects the charge entry, claims processing, payment processing, appeals and collections processes.  If your data and processes are not accurate, you will spend exorbitant amounts of time, energy and even money tracking and pursuing claims.  You must be attentive and accurate in every aspect of the process to be efficient and effective in your role as a medical biller.


6.       Requires Organization and Persistence

Medical Billing requires that you be organized.  You need to know where all your files are kept, keep an original of all forms required, create a process with procedures in place to accomplish all duties from start to finish, and attend to the smallest details.

Medical Billing requires persistence on every level.   Pushing things off to a later date, letting things slide as not being important, giving up when you know the data you have is accurate, and not providing follow thru will not only hurt the reimbursement for you and your physician, it creates unnecessary issues and further paperwork along with additional follow-up which can be prevented.


7.       Read all literature you run across

We all get inundated with paperwork, newsletters and articles.  Remember that it is very important that you stay informed on the updates that are produced by various networks, organizations and companies.  Use this to your advantage so you never are caught unprepared or uneducated.


Utilize these 7 steps and you will have a foundation for becoming an excellent Medical Biller!  We wish you great success!  If we can assist you further, please to not hesitate to contact us at 817.239.6595.


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