A Medical Billing and Coding Salary Comparison

Many people just starting to consider an administrative career in the healthcare industry are attracted by the fact that medical billing and coding is one of the fastest growing sectors over the past ten years. But once their research gets under way, it soon becomes obvious that aiming to earn a medical billing and coding salary isn't as straightforward as it seems.

The thing is, medical billing and coding, although closely linked, are in fact entirely separate disciplines. And once this fact becomes apparent, the inevitable question arises as to whether a medical billing salary is on a par with a medical coding salary, or whether one pays better than the other.

Comparison of a Medical Billing and Coding Salary

Firstly, we need to be clear as to what are the differences between the two areas. After all, if you are more comfortable dealing with numbers than people, then maybe you should aim to qualify as a medical coder.

Whereas, if you would rather pull your fingernails out than spend your working life manipulating numerical data, then you would be more comfortable with the duties of a medical biller.

Duties and Responsibilities

A medical biller is more akin to being a practice manager than a practice accountant. Whilst the task of compiling and submitting the required invoices to medical insurance companies or direct to patients, your job will involve patient liaison to a large degree.

From making appointments, greeting patients and their families to dealing with doctors, physicians and healthcare specialists, the job of a medical biller requires a far higher degree of people skills than maybe a medical coder does.

Certainly, a working knowledge of medical codes is essential for compiling patient records and accounts, but a specialist medical coder will be far more focused on data and numerical work than in dealing with doctors and patients.

So what is the implication for a difference in a medical billing and coding salary?

Initially, new employees in their first job after gaining their qualifications, be that in billing or coding, can expect to earn roughly the same amount. An hourly rate of between $10 - $14 is usual and is only influenced by whether the position is with a large or small organization and whether that organization is situated within a major city or rural town.

Once an amount of experience has been gained, the two disciplines begin to pull away from each other slightly. Certified medical coders with commensurate experience enjoy more satisfying salary levels than their unregistered and inexperienced counterparts. An average medical coder could reasonably hope to earn anywhere between $35000 - $45000 per annum.

A similarly qualified and experienced medical biller may find that their earning capacity is slightly lower at around $32000 - $43000 pa. However, those with specialization and experience encompass both areas are best placed to reach a salary level of up to $50000 pa or even higher. The inevitable conclusion to be drawn is that is you wish to earn a good medical billing and coding salary, then your best course of action is to qualify for both disciplines.

Prepare for a Career As a Medical Insurance Biller and Coder

It would be virtually impossible for hospitals, physicians and other health care facilities to operated efficiently without the assistance of professional medical insurance billing and coding professionals. Medical insurance billers and coders are distinguished by two hugely important roles within the medical coding environment.

What Does A Medical Biller and Coder Do?

Medical insurance billers and coders manage patient records, insurance billing, accounting and database entries. Medical insurance billers and coders working in the front office apply skills without having to work directly with patients.

The medical coder career field is perfect for someone who wants a job analyzing data and thinking about how to code a various items. The medical coder spends most of his/her time assigning codes for various medical procedures. Every medical diagnosis or procedure within a health care facility must be assigned a proper code so that the office can file for reimbursement from an insurance company. Medical billing coders can work in doctor's office, hospital, or other health care office. Some medical coders can work for agencies that take work from nearby medical clinics that outsource the work to them.

Every medical diagnosis or procedure within a health care facility must be assigned a proper code so that the office can file for reimbursement from an insurance company. Medical coders can work in doctor's office, hospital, or other health care office. Some medical coders can work for agencies that take work from nearby medical clinics that outsource the work to them.

Qualify to Pursue Multiple Medical Insurance Biller and Coder Career Paths

Medical insurance billing and coding is a stimulating field that requires individuals to be extremely detailed oriented. They must also be able to quickly adhere to industry norms. Errors that lead to underpricing a service or product, coding incorrectly, or missing a charge or payment can often lead to losses in a medical practice's income. The need for error-free coding places a high premium on coders who are highly proficient in their profession.

Career opportunities for medical billing coders include, but are not limited to, doctors' offices, medical billing agencies, health care clinics and medical facilities.

Medical Insurance Billing and Coding Certification

A number of employers prefer to hire candidates with certification credentials. A certification can help assure employers that prospects posses the necessary qualifications and skills to be successful on the job.

Experience gained on the job, along with a certification, can help prepare an individual to advance into management positions or health care areas that require specialty expertise.

How CPT Code 99355 Can Help You Capture Extra Time Spent With Patients

We have previously discussed using prolonged visit code CPT 99354 for prolonged patient visits. Today we will be discussing another CPT code that will help you capture revenue for the time you spend taking care of seriously ill patients in your office. That code is CPT code 99355.

CPT 99355 can be used when you are spending more than the standard amount of time you would normally spend with a patient. For each additional 30 minutes of face-to-face time spent with a patient, you can bill code CPT 99355. You will, however, need to list this code separately in addition to the code used for the prolonged physician service.

Many physicians do not use CPT code 99355. If, however, you are spending the extra time caring for a patient you do deserve to be compensated for your services. Just make sure that you document your time properly and provide the necessary Medical Necessity components when using the code.

According to the Medicare Manual, you must document the date and the start and end times of the time you spend with a patient. Only the time you spend with the patient counts. The time your staff spends with a patient cannot be billed with code CPT 99355.

The amount of time you can receive by billing with CPT 99355 will vary depending on the region of your practice. The average reimbursement amount for this code is in the range of $95.00.

Understanding Your Options

If you are caring for a seriously ill patient, you deserve to be paid for the extra time spent with that patient. For example, if you are treating the patient in your office and are spending a significant amount of time with the patient deciding what the best course of care will be, you have a few options for capturing this time.

If you spend more than 40 minutes with this patient and the visit meets all of the criteria, you can bill for a 99215 visit. If, however, you spend another half an hour with the patient above and beyond that 40 minutes, you can bill with CPT code 99354. Additional half hour increments can be billed using CPT code 99355.

An Uncommon Occurrence

It is not common for physicians to spend more than two hours with a patient, but it does happen on occasion. When it does, you deserve to be compensated for this time. This is why it is important to understand CPT code 99355.

Documentation is Key

While CPT code 99355 can help you capture the revenue that would otherwise be lost when spending extra time with patients, you must document your patient visits properly. This means recording the start and end time of the patient's visit as well as any face-to-face time spent with that patient.

Let's say, for example, that a patient comes into your office with a flare-up of COPD. You may start the patient with an oxygen treatment in your office while performing your physical and medical decision making and your medical history documentation. You are also spending time reviewing medical records and deciding the proper course of treatment. Let's say you then decide that your patient needs a nebulizer treatment and you leave the room to see another patient. You need to document the time you spend with that patient up until the point you leave the room. The clock stops once you are no longer in front of the patient. Once you return to the room with the patient, the clock starts again.

For all of the extra time you spend with a patient, you can continue to accrue time towards CPT code 99354. If additional time is spent above and beyond that code, you can accrue time towards CPT 99355.

Time is Money

With today's economic struggles and financial cut-backs, proper billing can make or break the financial well-being of a medical practice. Because of this, you need to ensure that you are capturing as much revenue as possible for your medical practice. If you are providing a patient with extensive care, you deserve to be compensated for the time spent. You owe it to yourself and your practice to maximize your revenue, and that means billing with code CPT 99355 when the situation warrants it.

Just how much of a difference can CPT code 99355 make? Let's say you only billed using code CPT99214 for a visit with a seriously ill patient. You would generate approximately $90.00 for 135 minutes of your time spent. If, however, you spend 135 minutes with a patient and bill using code CPT 99215, CPT 99354 and CPT 99355, you would be able to generate $120 plus $95 and an additional $95 for a total of $310. That is more than three times the revenue you would have generated using the lower CPT code. You owe it to yourself and your practice to use these codes whenever possible and maximize the revenue brought into your practice.

Using Medical Necessity Effectively When Coding Patient Visits

Proper billing and coding practices can make or break the financial well-being of a medical practice. Understanding the rules that pertain to billing and coding can increase the revenue generated for your practice and can alleviate concerns regarding level of service requirements.

Physicians spend years obtaining the education that is necessary to practice medicine, but the billing and coding of medical claims is not a standard part of the medical curriculum. The fact of the matter is, understanding billing and coding is as crucial to the financial well-being of your practice as your medical education is to the physical well-being of your patients. Whether your practice has an in-house employee handling your billing or you outsource your billing and coding to a professional agency, you as the provider are ultimately responsible for the level of care you provide to your patients.

The evaluation and management (E/M) codes used in medical billing can be a significant source of revenue for your practice. While you, as a physician, understand the concept of Medical Necessity and you believe that you are providing your patients with necessary medical care, why is it that you are denied payment for a visit or a procedure that is considered unnecessary by someone who is not a medical professional? How is it that this person can judge whether or not the treatment was necessary when they were not there at the time of the visit?

The idea of Medical Necessity is a cloudy concept. It is described in less detail than many of the other coding definitions. Because of this, you should familiarize yourself with the concept of Medical Necessity if you hope to avoid denied claims and delays in payments to your practice. If you want to prevent denied claims and payment delays, you must ask yourself some questions...

What Constitutes Medical Necessity?

There are three components to the E/M guidelines including the patient history, physical exams and medical decision making. The determining factor in the level of care that you provide to a patient is the Medical Necessity component. This is also the deciding factor in how that level of care is billed to the patient's insurance provider.

Different insurance companies may have specific definitions of Medical Necessity. Medicare guidelines are what most insurance companies follow in regards to paying a claim. According to Section 1862(a) (1) (A) of the Social Security Act, Medicare does not pay for services that are not reasonable or necessary for the diagnosis or treatment of an injury or an illness or to improve the functioning of a malformed body member.

The AMA Model Managed Care Contract is a sample contract used to help physicians negotiate with health plan providers. This contract suggests that the definition of Medical Necessity is services or procedures that a prudent physician would provide to a patient in order to prevent, diagnose or treat an illness, injury or disease or the associated symptoms in a manner that is:

a) In accordance with the generally accepted standard of medical practice.
b) Clinically appropriate in terms of frequency, type, extent, site and duration.
c) Not for the intended for the economic benefit of the health plan or purchaser or the convenience of the patient, physician or other health care provider.

What Does Medicare Say about Medical Necessity?

According to the Medicare Claims Processing Manual, Medical Necessity is defined as "The overarching criterion for payment in addition to the individual requirements of a CPT code. It would not be medically necessary or appropriate to bill a higher level of evaluation and management service when a lower level of service is warranted. The volume of documentation should not be the primary influence upon which a specific level of service is billed. Documentation should support the level of service reported."

What this tells us is that a provider is allowed to bill as high as the Medical Necessity warrants as long as the physician properly documents the office visit and meets all of the History, Physical Exam and Medical Decision Making criteria. If, however, the care that is provided to a patient is above and beyond Medical Necessity, the physician can only bill as high as the Medical Necessity warrants.

Putting the Pieces Together

There is one determining factor when navigating the murky waters of Medical Necessity and that is having a clear medical reason to perform a service or procedure. If there is clear medical need for the service or procedure that you are performing, then the Medical Necessity requirements will be met. For example, if you have a patient who comes into your office with difficulty breathing, you would absolutely have to perform a comprehensive medical history in order to address the issue. Each component of that history, such as the ROS, HPI/CC and PMFSH would be needed to obtain clinically relevant information.

The HPI you perform would help you obtain the information needed regarding the patient's current condition including the duration and timing of the symptoms. The ROS would then help you determine which systems are being affected by the condition and which diagnoses could be considered. At this time you would also learn about risk factors that could contribute to the patients current condition. All of these components would be medically necessary in order to provide the patient with a proper diagnosis and effective treatment, thereby meeting the requirements of Medical Necessity.

Now, let's say the same patient comes back to your office for a follow-up visit a few weeks later after being treated in the hospital for pneumonia. The patient has no particular complaints and seems to be doing well. You would not be able to justify a comprehensive medical exam at this point because there would be no clear Medical Necessity to perform one.

As a rule of thumb, consider whether or not the services you perform will help you modify or contribute to a patient's current visit or therapy. If not, then it is not medically necessary and does not meet the Medical Necessity requirements.

Medical Decision Making vs. Medical Necessity

Many physicians confuse Medical Necessity with Medical Decision making. In order to eliminate this confusion, it is easiest to consider the Medical Necessity component as a part of the Medical Decision Making process.

There is no denying that Medical Necessity is a vague and poorly-defined concept. It is open to different levels of interpretation and, in the end, the final determination regarding whether or not something was medically necessary is up to an individual who is not even a medical provider and was not present at the time of the service. Because of this, it is important that you document the intensity of the visit as well as the key components in order to code your visits properly and maximize your practice's incoming revenue.

Getting Paid for PT/INR Office Testing With CPT Code 99211

Many doctors understand how to code properly for their time spent with a patient, but the waters become murky when it comes to coding for the time that their nurses spend on face-to-face visits. This is largely why CPT code 99211 is often underused.

As a general rule, CPT code 99211 is a "nurse code" that is used to bill for time that your practice's nurses spend with your patients. Some physicians wonder if it is appropriate to use CPT 99211 for face-to-face time spent with patients and, if so, how it should be used.

Using Code CPT 99211

According to the Medicare guidelines, even though CPT 99211 does not require a physician to be present in the room with a patient at the time of the visit, the service must be performed face-to-face with one of the physician's staff and the physician must be immediately available during this time. The visit must also have an impact on the patient's care, such as a change in medical regimen in order to be eligible for CPT 99211 coding.

To determine whether or not a visit can be billed for using code CPT 99211, there are some questions you should ask yourself:

1. Were you, the physician, on site when the visit with the patient was conducted?

2. Was the visit pertaining to a service that was medically necessary and was there a change in medical routine as a result of this visit?

3. Was the patient physically in your office (not on the phone) and did you or your staff have face-to-face contact with the patient during the visit?

Whether or not you can bill using CPT 99211 will depend on the answers to all three of these questions. If you can answer yes to all three of above questions, then the visit you are billing for will likely meet the requirements to capture revenue using code CPT 99211.

The following scenario is an example of when CPT code 99211 could be used effectively for PT/INR testing in your office...

Let's say you have a patient who is taking Coumadin/Warfarin Sodium. This patient comes into your office for a routine PT/INR test. You are in the office at the time of this visit, so the visit meets the first requirement for CPT 99211 coding.

Your nurse performs the PT/INR test and shows you the results of the test while that patient is still in your office. You see that the PT/INR levels shown in the test results warrant a change in the patient's prescription dosage. Because of this, the visit now meets the Medical Necessity requirement for CPT 99211 coding.

Your nurse then returns to the patient and informs your patient of the changes being made to their prescription dosage. The nurse then documents the patient's record while that patient is still in the office. The "face-to-face" requirement has been met, again meeting the requirements for CPT 99211 coding.

Using the scenario above, you would be able to bill for this visit using code CPT 99211. Now let's look at a scenario where you would not be able to bill using CPT code 99211.

The same patient comes into your office for a routine PT/INR test. You are in your office at the time of the visit, meeting the first requirement for CPT 99211 coding. However, the test results come back normal and there is no dosage or medical regimen change. Because of this, the requirements of CPT 99211 are not being met and you will not be able to use this code for billing for this visit.

Here is another scenario where CPT 99211 would not be used...

Let's say the same patient comes into your office for the routine PT/INR test. The patient leaves your office before you review the test results and you call back later to give the patient instructions over the phone. Because the patient was not in the office at the time the results and instructions were provided, the "face-to-face" requirement is not being met and you can not bill using CPT 99211.

Remember, you must be able to answer "yes" to all three of the criteria questions if you wish to bill using CPT code 99211. If you can answer yes to all three questions, then you should, by all means, bill using the CPT 99211 billing code in order to maximize the revenue generated for your practice.

The Definition of "Time" in Regards to E/M Services

To meet the criteria of the "time" code, the visit must meet the following conditions:

· The office visit must be dominated by counseling, meaning that more than fifty percent of the time spent with the patient is spent discussing the diagnosis, the test results and treatment options available to the patient. This time can also be spent on patient education and discussing the importance of treatment compliance on the part of the patient.

· You must document the total time of the visit and must document that more than fifty percent of the visit was spent in discussion with the patient. You also need to document the nature of the patient discussion.

Remember, "time" can not be used as a descriptor for patient observation, visits to the emergency room or preventative medicine services. If a visit with a patient meets the above conditions, you can use the "time" code regardless of the level of history, exam or medical decision making made during the course of the visit.

The Impact on Level of Service

The level of service for the E/M code will not impact your billing if you spend more than fifty percent of the patient visit counseling the patient. Instead, you can choose the time element to qualify the billing of your visit. Just be sure to document that more than fifty percent of the time spent was spent in discussion with the patient so that you can properly capture the visit code.

Scheduling Family Visits

It is not uncommon for the family members of some patients to want to speak with you in your office. If you schedule visits with these family members alone without the patient present, you will not be able to bill for the time spent. While this may provide an outstanding level of customer service to your patients and their families, you do deserve to be compensated for your time. Instead of meeting with family members alone, consider scheduling family visits to coincide with a patient's scheduled appointment. If the patient is present during a face-to-face family meeting and the time spent on counseling exceeds fifty percent of the visit, you can capture the revenue for the visit as long as you properly document the progress notes.

Of course it is up to you to decide the proper way for you to discuss patient issues with a patient's family. You do need to be sure, however, that you have the proper privacy forms filled out and that you are authorized to discuss the patient's treatment with his or her family when divulging patient information.

Properly Documenting Your Time

Time can be a significant issue when you are seeing a patient to discuss a variety of concerns. Make sure that you take advantage of the rules that pertain to billing for time. By doing so, you will be able to maximize the revenue coming into your practice and will not go uncompensated for time spent counseling the patients in your care.

Converting to Paperless Records - Keeping With Electronic Health Records

More and more medical practices are converting to electronic health records than ever before. Not only are electronic health records easier to maintain, they are better for the environment and will cost your practice less in the long run.

Many medical practices overlook the costs of keeping paper charts. There are many costs involved with paper charts, such as the cost of the charts themselves and the costs associated with replacing and replenishing charts that wear out from continued use. Some practices spend more than $4,000 each year purchasing medical charts for the office. By converting to paperless record keeping, these practices can save a substantial amount of money over the years.

When you use paper charts, you must purchase new charts and inserts on a regular basis. Then you must pay for photo copy costs, toner, faxes and maintenance on the machines used for your record-keeping purposes. These expenses can add up to more than $2,000 annually. It is not uncommon for a practice to have between $5,000 and $10,000 in record-related expenses each year. If you take that money and invest it in an electronic record system, the system will eventually pay for itself over time.

Added Space and Convenience

Saved money is not the only reason so many practices are investing in electron records management. Imagine, for a moment, that you do not have to dedicate volumes of office space to endless patient files. Imagine that you and your staff will never have to search for a missing patient file. In fact, imagine that filing is a thing of the past for you and your staff.

Consider just how much time you and your staff spend each day filing records and searching for patient files. Consider how much of your practice's building space is dedicated to storing the files that contain your patient records. Now imagine those two factors are no longer an issue for your practice. That is exactly what electronic record keeping can do for your office.

Starting the Conversion Process

In theory, EMR will allow you to replace the paper charts you keep in your office. Of course, this isn't something that will happen overnight. You will need to begin the conversion process one step at a time, and the first step is recycling.

Once you have an EMR system in place, it is time to being the recycling of the paper charts that are used by your office. You can scan older patient records into an electronic database and recycle the older charts you no longer need. As new patients come in, you can begin using the EMR system to keep records for these patients, eliminating the need for paper charts altogether.

Putting Your Extra Space to Good Use

Once your files have been migrated into an electronic format, you will find that you have an abundance of space that is no longer dedicated to storing patient files. That extra space can be converted into additional treatment rooms.

Treatment rooms equate to money. These are the rooms that generate revenue for your practice. If at all possible, try to convert the space that was used for file maintenance into added treatment rooms for your practice.

If the space that was storing your patient records can not be converted into treatment rooms, do not leave the space unused. Instead, try to create work stations for staff to use for authorizations and referrals. Not only will you be saving money by converting your file management to an electronic format, you will also be generating added space for your practice and reducing stress and increasing productivity for your practice's employees.

Medical Billing Incentive Plans That Inspire: 10 Tips for Success

The best performance incentive plans are the ones that work, of course, but what works for employees - cash or days off - might not be what your organization can afford. Incentive plans that are effective at motivating billers must be affordable and targeted to specific results. Most importantly, they must be finite - that is, not a permanent entitlement.

Put careful thought into the design, goals and timing of any incentive plan - big or small. Use these 10 tips to shape your organization's incentives for billers:

1. Recognize that the revenue cycle is a function of many factors
Billing is an operational process, not a desk or a department. Your incentive plan should recognize that everyone in the organization plays a role in the process. Collection rates improve when front office employees remember to ask for copayments from every patient who owes one. Days in accounts receivables can decline if schedulers remind patients who call to schedule an appointment about any copayments or past-due balances. An effective plan influences behavior by tying rewards to specific targets; for example, always producing accurate registrations or always collecting time-of-service payments. Because many staff work in teams, base at least half of the reward on team performance and the remainder on individual achievement. It will give everyone a reason to work together.

2. If YOU don't have the money, don't even go there!
Nothing deflates employee morale faster than cancelling a popular incentive program. Keep your incentive programs cost under control by capping individual distributions at $100 per month or less. An exception might be when the incentive program is meant to replace part of employees' salaries. In most cases, you'll find that relatively modest incentives- $25 or $50 a month-are appreciated by employees and will inspire them to better performance.

3. You get what you pay for. If you incent for speed, you will get it - but also the inaccuracy that comes with higher speed.
Give careful thought to the range of unintended consequences your incentives might inspire. Want to reward a biller for posting claims faster? Don't be surprised if error rates go up because some employees skip important steps in their quest to work faster. Want to reward billers for resolving 100 percent of denied claims within 30 days? Be careful that they don't start reclassifying claims denied for missing documentation, unbundling, medical necessity and other 'noncontractual adjustments' as contractual adjustments (e.g., the contracted allowable discount). Of course, most employees are conscientious. All the same, don't be shocked when people go in the direction in which your incentives push them.

4. Not every account is the same.
Many organizations assign accounts to billers based on payer. That's helpful for building core knowledge about a payer. It's not so great if the new incentive plan holds the person working Medicaid accounts to the same standard as the person working Medicare accounts. Specialty differences also can make a big difference in how long claims remain in accounts receivable - and the work involved in getting claims paid. Before implementing your incentive plan, work with employees to 'weight' the various payers, using Medicare as the standard; they'll have a good sense of the differences. In many states, Medicaid consumes twice as many resources - and time - as Medicare; Workers' Compensation may be three times as hard. The weightings won't be precise, but your incentive has a far better chance of success if performance goals - say, 25 days in receivables outstanding for Medicare, but 50 for Medicaid - are relevant to the payer mix, as well as to your organization and your market. Expect to revise goals over time - a change in your computer systems or payer mix, or new software in the state's Workers' Compensation program - can change things dramatically.

5. Distribute in a timely manner.
Memories are short. Keep the incentives tightly linked to the performance by distributing rewards soon after the end of the monitoring period, no more than 30 days. Because monetary rewards are - sadly - taxable income, you might find it easiest to distribute them as part of the employees' regular paychecks. Make sure to give each employee earning a cash incentive a written statement of the gross amount of the reward. Distribute the statement separately, either with or before payroll distribution, so employees can see what they earned before Uncle Sam and the state took their cuts.

6. Establish clear expectations regarding measurements, including formulae.
A clearly drawn incentive program is immediately understandable and can be easily tracked by participants. If the plan is too complex, billers won't understand what you want them to accomplish. Worse, they question the plan's - and your - fairness. If the indicators and formulae are clear, employees will know what to do reach your intended goals. Spur competition by making and displaying charts of progress on indicators or distribute printouts at each staff meeting. It will make a bigger impact than burying the progress reports in the computer network.

7. Keep in mind...less is more.
The mantra "less is more" isn't just for environmentalists. Small rewards - $25 to $50 per month - can be quite effective. Ask billers to suggest reward amounts; you might be surprised at the relatively modest amounts they consider worthy. The same goes for incentive plan criteria: keep them short and sweet so everyone will understand what they need to do to succeed.

8. Put the plan in writing.
It sounds so obvious, but your plan must be written down and readily available to employees. Hand out copies when you announce the plan and put copies on your organization's intranet or internal server.

9. Evaluate annually.
Review your incentive plan's overall results annually against the performance it is supposed to inspire. In some cases, you may be able to put a cash value on the plan's impact: for example, the number of reduced denials from practice-caused errors times the cost of reworking a denied claim. Once you reach a goal, such as collecting 100 percent of patient copayments at time of service, move on to other targets.

10. Consider non-monetary awards.
The problem with most financial incentive plans is that they become an expectation, which means they are no longer motivating better performance but merely maintaining the status quo. Staff may come to view the additional cash as part of their normal compensation. They may even start depending on it. After the plan expires, morale (and results) can suffer as staff perceive that you took something away from them.

You can alleviate many of these issues by sticking to short-term plans-three to six months. Better still, consider a non-monetary incentive plan. Non-monetary awards can work well, and maybe better than cash awards, because they are perceived as more spontaneous and sincere.

Try these ideas to reward billers for reaching goals:
Offer an award - a fancy trophy, or a simple certificate.
Give a bag of popcorn, two movie passes and a note that reads: "Thank you for all of your hard work; Hope you'll relax this weekend!"
Place a rose in a vase on the employee's desk with a note that reads: "For all you do, this bud's for you!"
Send a bouquet of flowers to an employee's home with the message: "Where would we be without you? Thank you!"
Provide complimentary dinner delivery - or make trays of lasagna for everyone; accompany with the note: "Thank you for your hard work - hope you'll take the night off"
Don an apron, and walk around with ice cream sundaes and fixings.
Host a BBQ behind your building - for lunch, or take home.
Allow a casual dress Friday.
When choosing incentives - and there are as many as you can imagine - opt for the ones that best fit your management style and your organization's culture.

Medical Billing And Coding - Start A Business And Work From Home Or Get A Job?

Many people interested in the medical billing field as a career or medical coding profession have wondered whether they should get a job as a biller or coder or start a business and work from home. Many need the security of knowing they're getting a paycheck every week or two and others don't realize exactly what it means or what it takes to start up a medical billing business.

Although I do know someone who started her own business right after getting medical billing training it's not the usual course after one gets their education or training whether from an online school or from their local college or university campus. If you're inexperienced in this field it is much better to go to work for a billing service, hospital, clinic or doctor's office to get some good experience first and then decide what to do.

Even after you get a little or even a lot of experience, starting a business at home requires some upfront money and most of all clients, not to mention all the requirements of local business licenses and overhead. Getting your first client will be difficult without being able to give testimonials from clients you've already done work for. Buying medical billing software can be expensive also and there is a learning curve to contend with. The software is complicated and isn't as easy as just plugging in some numbers. Every insurance company and medical office has different rules to follow and this requires some time to master.

After you have scouted out all the local billing services and talked to people in the human resources departments to find out what jobs come up occasionally you'll know if there are sufficient employment opportunities in your city or town. This will be where you want to start whether you decide after getting some experience whether you want to start a home business or not.

So when mulling over whether to start a business and work from home first or get a job and work for a billing service, hospital, doctors office or other company that needs to hire billing employees, it would be safe to say it's probably not a good idea if you don't have the experience or a client lined up already. If you know a doctor who would be willing to give you a chance and your rates are significantly lower than the billing service he uses you may want to consider it. But take online or on campus courses and classes first to make sure you like the medical billing industry. There is federal money and financial aid available for online courses to save you money upfront. Make sure to research the colleges or online schools to make sure they're accredited by a recognized accreditation association.

Medical Billing - Reduce Your Health Care Costs by Making the Most of Your Doctor's Appointments

You may think as a patient, collector is the last person you want to see at the doctor's office. Why? Patients are afraid to deal with their medical bill that their insurance don't cover. Patients' think medical biller is just to collect payments from them. Patients don't want to find out what their responsibilities to pay the services they received from the physicians.

Biller is the best person to help patients and physicians to understand the benefits of having insurance. They are the one that verifies eligibility, insurance coverage for specific visit or procedures. Patients may not know who's the doctor that participate in their insurance or what facility that has contract with their insurance and this is where medical biller comes in. Medical billing services in doctor's office is a big help in everyday venture. They are there to help physicians and patients to focus on what's important- Health care. Before doctor's see the patients. patient services will collect insurance information, call insurance to verify for coverage, if patient has copay for each visit or even authorized for services. This will eliminate disturbance between doctors and patients time. Doing this ahead of time will be better in office set up. The doctor and patient relationship will focus on the treatment for what is important. It is less waiting time to see the doctor, less time sitting in the waiting room area of the doctor's office. It will put a smile on patient's face.

Now with changing world, there's a multiple physician's specialty, multiple insurance between HMO and PPO rules and policies to deal with. Medical Biller is an expert in dealing with this issues or challenges that comes between patients and doctors. They help in figuring out where patient can go to see a family physician, a specialist, verify what kind of benefits that patient has, what is covered and what is the share of cost for the services. It will give them peace of mind knowing the details of their visit and what to expect after the visit.

As you can see the importance of this position in the flow at the doctor's office or other health care facilities. They help facilitate a better way to handle issues with insurance, file claims in timely manner, verify eligibility before patients get to see the doctor. It eliminate health problems and stress after receiving medical bills. They are there to smooth and ease the flow in the office. It is a better way not to waste time preparing paperwork and use the time in patient care.

Medical Billing Software - 10 Questions To Ask Before Making Your Purchase

Avoid buyer's remorse. Do your homework before purchasing medical billing software for your practice or billing service. Review and think about these 10 questions prior to scheduling software demonstrations. Make your buying decision based on facts rather than emotion.

What are ALL the costs associated with this purchase?

When buying a medical billing software system, the software itself is only one of the costs in the total purchase price. Other initial costs include hardware, installation, and software training. Ongoing costs include software upgrades, technical support or maintenance, and electronic claims billing. These costs vary depending on the type of system.

Some desktop systems require expensive hardware. Web-based medical billing software has fewer hardware costs but higher monthly maintenance costs. Avoid costly surprises by obtaining all this information in writing prior to making a commitment.

Is the software easy to use?

A medical office is a very busy place. You don't have the time to spend on the phone with Technical Support trying to figure out how to bill a claim or reprint a statement. Software should be intuitive and easy to use. Naturally, you have to expect to spend some time learning the nuances of your software, but most functions should be intuitive.

How long has the software been in use?

I ask this question because, there is no such thing as bug free software. The longer the software has been around, the more likely the bigger defects have been worked out.

How long has the company been in business? How many employees do they have?

If a software company is too small, they may not have a staff that is large enough to handle big upgrades or unforeseen system problems. The longer they have been in business, the better.

What type of software training program does the vendor offer?

Online training is best because you can schedule shorter training sessions. Periods of 2-4 hours are ideal for new system users. Avoid the full day, on-site training sessions when possible. They are convenient for the vendor but not cost effective for the practice. The office staff tends to burn out by the end of the day and forget a lot of what has been covered. Most people learn by doing. Don't schedule your training until you are ready to use your system.

How good is the Technical Support?

When I first start working with a new software vendor, I pick up the phone and call Technical Support and start the timer. How long does it take for them to answer your call? Also, beware of companies that rely primarily on email and fax support. Software vendors cut costs by handling their technical support this way but it is very inconvenient and time consuming for you.

What EHR (electronic health records) software does the medical billing software integrate with?

One of my clients decided to buy an electronic medical records software package that did not link to his medical billing software. The salesman told him that it was no problem. They could develop a link for him. A year later, they have no link and his office staff is still entering demographic data into two systems.

The best medical billing software is one that has a built-in HL7 link that will integrate with several different electronic health records systems.

Does the software address the critical needs of your type of practice?

Just because the software works great for Dr. Smith's office down the street, doesn't mean it is automatically the right software for your practice. Let's say Dr. Smith is a specialist and you are a family practitioner. A software feature that allows you to lookup CPT and diagnosis codes by description isn't all that important to him, but it certainly is to you. Make a list of the features in your existing software that you love, what you don't like, and what you'd like to have.

Expensive software is not necessarily better. It's a fact that most people use only a fraction of the features in their software. The question to ask yourself, do I really need all the expensive bells and whistles?

Keep in mind your most basic features: scheduling, HIPAA compliance, electronic claims, patient statements, Aging Reports. Advanced features will include medical coding software, revenue and insurance denial management, automatic EOB posting, and insurance eligibility.

Can you take a test run of the software or is an online demonstration available?

Typically, an online software demonstration doesn't give you the time you need to adequately review a medical billing software system. Don't be shy about asking for access to a sample database to play with. Some software vendors offer downloadable demos that you can install and try out. If that option is unavailable, find out if there is an office nearby that uses the software and ask the office manager to show you the software. Most people are quite agreeable to do this.

Get references.

Most people make purchases based on emotion. Salesmen are salesmen and they will offer you the sun, the moon, and the stars to get you to buy their solution. That's why it is so important to obtain SEVERAL references of practices that have been using the software for at least a year, not just a few weeks. If the vendor can't provide them, walk away.

Preventing Medical Billing Fraud

According to experts in medical billing, the government loses thirty cents per dollar earned due to fraudulent practices that happen in the medical community. Medicare fraud is a felony and suppliers, recruiters, providers, beneficiaries and companies of medical services can commit it. Types of medical billing fraud include writing bills for services that have not been provided, billing services that are not covered as services that are covered and unbundling of services among other activities.

There are many ways in which an office can prevent billing fraud. One of these methods is through screening employees. Any employee applying for a position as a medical biller should pass through screening, which involves performing a background check and asking to see the candidate's billing certificates.

The other way to prevent medical billing fraud is to set up a compliance program that will allow you to prevent fraud.

Such a program should be overseen by personnel granted the responsibility to recommend consequences once he or she detects fraud. The reason of the program should be communicated to all employees, letting them know of the procedures and standards involved in it. The other thing that an employer can do to prevent medical billing fraud using the compliance program is to include a method designed to report abuses without fearing penalty and retribution if an employee breeches the standards of the program.

The other way in which billing fraud can be prevented is through compliance with the Health Insurance Portability and Accountability Act (HIPPA), which is a federal legislation that is intended to offer protection to a patient's personal health information and privacy.

This legislation ensures that a patient's protected health information, which includes any information that can identify a patient, is kept secure. This information includes patient names, medical records, social security numbers and addresses.

The precautions that an office can follow in order to ensure that the information remains secure includes ensuring that computers are password protected so that others cannot view patient information, ensuring that fax machines are placed in areas where the public cannot access them and encrypting emails that contain patient information. In addition to this, the people having access to a medical billing office should sign a confidentiality statement.

These practices should apply also to a third party medical billing service and this can be done through the use of business associate agreements and contract clauses.

Medical Billing Books - Important Considerations Before Buying

If you search the Internet for Medical Billing books, the choice can be overwhelming and it's hard to separate the pretenders from the experts.

Not only are conventional books available from traditional sources, but ebooks are becoming even more popular as you can download your book in electronic form instantly. These are typically in PDF format but can also be in standard word processing format.

The Author

Probably the most important consideration when purchasing a billing book online is the source. Before you rush and click on the "Add To Cart" or "Buy It Now" button, examine the credentials of the author. Any reputable author should share their credentials and accomplishments.

Whats their background? Do they have extensive experience in the profession or are they just trying to sell something? If they have to rave about how much of an expert they are, that may be a warning sign. If someone is successful in their field, their record will reflect it.

One Size Does Not Fit All

It's hard to find one comprehensive billing book that covers all the topics in the field adequately. All the topics in billing can't be condensed to fit in one book and provide any real substance or useful information.

To learn about the basics of the profession, an introductory book should include: 

• Claim processing - Deductibles, Co-Pays, & Co-Insurance
• Primary, Secondary, & Tertiary Insurance
• Commonly used forms
• Medicare and Medicaid, Workers Comp HMO's, and PPO's
• Reading and Understanding EOB's (Explanation of Benefits)
• Patient Billing
• Aging reports and working accounts receivables
• Terms commonly used
• HIPAA
• Training and what you need to know
• What ICD diagnosis and CPT procedure codes are and how they are used in medical billing

An introductory book on the subject should include a good description of the billing process, responsibilities, and what to expect.

Business

If wanting to start a home business, get a book written by someone who has started a successful billing business or currently operates one. Their advice will be a lot more valuable than someone who writes a book about starting a business and tries to apply it to medical billing. The unique challenges and character of the medical billing business can only be explained by someone who has experienced it.

For useful information on starting a business, a medical billing book should at least cover: 

• Contracts (this could be a separate book in itself)
• How much you can expect to make
• Whats necessary to start a business
• Pricing your services
• Software, electronic claim filing, and the clearinghouse
• Business plan

Marketing Your Services

Marketing a medical billing business is a topic worthy of a book on its own.It's important to find a good source for marketing ideas if starting a business.

Getting a client - this one is very important. One of the biggest challenges when starting a medical billing business is convincing a doctor to give your billing service a chance. What are the credentials of the author? Have they operated a successful business? Do their techniques seem realistic or is it just a thinly veiled attempt to get you to buy a "Business Opportunity", training program, or overpriced practice management software.

Marketing books should cover: 

• Innovative marketing techniques
• How to find clients and what they want to hear
• What to say when you meet with a doctor or office manager
• What services to offer to distinguish you from the competition

In summary if you want to learn about all the different facets of billing, obtain books from a credible source and plan on using multiple resources to reach your career objectives - be it to get a steady job or start a business.

How to Handle Medical Billing Code Changes

Medical billing codes undergo changes on a yearly basis. When they become outdated, insurance companies cannot accept them any more. Your claims will therefore be denied because of the codes.

There are few ways in which you can keep up with changes in medical billing codes. The first thing that you can do to keep updated codes is to use Current Procedural Terminology Code Books. These are billing code books that have an explanation for each medical billing code. They list the codes alphabetically and by number.

The codes found in CPT books are updated annually and the changes may be minimal at times, while at other times they may have a lot of changes. The books also contain a list of modifiers, which indicate that a service was changed in a certain way from the stated current procedural terminology without changing the definition. By ensuring that you have these books on a yearly basis, you will be able to keep up with any billing code changes that have taken place.

You can also handle code changes by using the code book known as the international classification of diseases, ninth revision clinical modification (ICD9). This is a coding system that groups related disease procedures and entities for the reason of reporting statistical information. ICD9 books also list diagnoses both numerically and alphabetically and the codes are updated on a yearly basis.

The other way to handle code changes is to purchase medical coding software, which is a good alternative to code referencing books, which you need to update on a regular basis. The other benefit that medical billing software offers is that you do not need to consult a number of books in order to code a medical procedure correctly. Electronic medical software eliminates the problem and in addition to this, it provides online searching capabilities that you cannot achieve with reference books.

Medical office software is the best method that you can use to handle code changes because it will provide you with more accuracy. Medical offices that utilize online coding and billing software will find it easier to transition from the old codes to the new codes because the software will handle much of the work. By keeping up with code changes in this way, your billing practice will improve the quality of care that you deliver.

Finding the Best Medical Billing Schools

If your dream of being in the hospital billing profession seems like a long shot from where you are now, being able to pick one of the medical billing schools in the country can be the first step to realizing your goal. For starters, you have to understand that medical billing schools are institutions which train professionals in the process of billing and coding. This means that healthcare billing schools will be able to train people professionally in the areas of following up on claims with insurance companies in order for the hospital to receive the payment for the services it rendered. In conclusion, medical billing schools can train people about the basics of insurance policies, communications, legal systems, and other practices in order for the industry to work as smoothly as possible.

But, given the fact that there are a lot of healthcare billing schools in the country today, you might be wondering which one will be the best for you. So, here are some tips in order for you to make the right choices with regard to a medical billing school:

First, make sure that your school of choice is nationally accredited. This means that they have passed, at least, the bare minimum of what the government and the medical industry expects of them. Having a license also means that they are within government jurisdiction. This means that people running the institution can be legally liable in the event that they do something that can be considered fraudulent and bordering on illegal.

Secondly, medical billing schools are supposed to have a strong inclination towards the medical industry. Make sure that your institution of choice has a strong faculty. They should be experts in different fields in order for them to have the credibility in explaining procedures, and ethics involved in the healthcare billing industry. Experts should also help you understand the concept of insurance cycles, and general coding systems. Also they should understand patient confidentiality clauses as well as the HIPAA or Health Insurance Portability and Accountability laws.

At the end of the day, it is safe to assume that the future of healthcare billing is on an upward trend. You just need to decide if this is the right career choice for you.

Understanding Medical Billing Jobs

If you think about it, medical billing jobs are essentially jobs that are mainly responsible for billing and collecting all of the professional fees for healthcare and medical services provided to patients. As such, those in the healthcare billing profession are tasked with sending out claims to insurance companies, posting payments, responding to external information requests related to claims filed, following up on claims without responses, communicating with patients or the insurance companies regarding denied claims, claims in review, or pending reviews, sending out statements to patients, and turning over delinquent accounts to debt collection agencies. Medical billing jobs might not be as simple you think. Billing is generally a simple task but those with these jobs have to be equipped with broad knowledge and understanding of the entire billing process, as well as all rules followed by health insurance companies.

So why should you consider medical billing jobs?

Those in the this profession receive a median salary of around $30,000 every year. That's incentive enough for a lot of people to go and take up training for this profession. What's good also is that healthcare billing jobs do not necessarily mean working in a hospital. Healthcare billing touches up on everything that involves billing that is medical in nature. So that means, jobs in healthcare billing might be available on the end of the insurance companies, doctors offices, pharmacies, and nursing homes. Since insurance concerns touch up from time to time with matters of the law, a medical billing job can also find you working for a law office.

But can't doctors do their own billings?

Technically, yes. But this job requires an entirely different kind of training of the administrative kind that most doctors just don't have the time for. And even if they do find the time to train, the actual process of billing will take up so much of their time that they might not have any left to actually be doctors. It's not like they can do away with billing also that's why there are a lot of medical billing jobs around. Just imagine how many doctors out there will need help. Doctors need medical billers and that opens up opportunities for you.

Getting trained

As with any profession, this career require intensive training. It will be your job to ensure that all bills are free of errors so you have to know everything there is to know about healthcare billing and all related services. You can easily search for medical billing schools online so you can get started on that all-important training as soon as possible.

How Communications Affects the Relationship Between a Provider and a Medical Billing Service

In order for the billing to be done effectively it is crucial that the relationship between the billing service and the provider's office is a good one. Frequent communications with your providers is key to a good relationship. It is important to keep them abreast of everything that is going on with their billing and all that you are doing. When we first started our business we didn't see the point in telling a provider that we were taking care of a denial or appealing a particularly difficult claim. We assumed he knew we were taking care of it. But experience showed us that this is not necessarily true and you need to find a way to keep your providers up to date on the status of their accounts without bothering them.

Some providers say they don't want to know about the issues, but someone in the office should be watching for what the issues are. You don't have to speak to the provider every time you communicate. You can have a weekly fax or email that just gives the highlights of the issues for the week. It is important that they know that any issues that come up are being taken care of and you are showing them this by your weekly communication.

When there is no communications between the provider and the biller, the provider may assume that the biller is not doing that much because the biller isn't telling the provider about all the things that he or she is doing. It is amazing how many things we do for providers that they never realize. If you don't let them know then they don't know you did it and they don't realize all the services they are getting.

We work for many small providers who don't keep track of their claims payments. Their whole perception of what is getting paid and what is not getting paid is based upon two things. Do they have any money in their checking account and the explanation of benefits they get from the insurance carriers. They rip open envelopes and tear off checks. If there is no check some only wonder what happened. They often do not understand the reason codes and have no idea why there isn't a check attached. While we may be resubmitting a claim with a corrected diagnosis or ID#, one eob comes through as a denial before the second one comes through paid. Some doctors never notice that they were for the same claim. They only notice that one didn't get paid.

To keep our providers updated of what we are doing, we send a simple fax or email when we complete the billing for the week letting them know what the issues were. It might read something like this.

Dorothy Winn-has incorrect ID# - do you have a copy of her ID card?

Melvin Black-appealed denial for timely filing with electronic reports

Mara Rosen-clearing house report states she no longer has that Blue Cross policy-so you have new info?

Much of the work you do is not just the data entry of the claims and payments but your providers may not have a clue as to the extent of this other work. If you are in the habit of letting the provider know, they will value you even more.

A lot of times billing services think that if they are not hearing from the provider then he/she must be happy. That is a really bad assumption. They may be thinking anything from "Wow my billing service is great!" to "Man, what are they doing over there? Sitting around playing solitaire?" If you want to be successful you really need to know what they are thinking. The best way is to ask. There is nothing wrong with getting in touch with a provider and saying "things appear to be going pretty smooth from our end. How do you feel they are going? Is there any areas you are concerned about?"

If they are worried about something they should tell you. Then you can either rectify it if it is something wrong, or clarify it if it's a misunderstanding. Many billing services have lost clients based on lack of communication. It's something that can be easily rectified.

Training a Medical Biller

Training to become a medical biller can be overwhelming. Whether you are an employer who needs to train employees or you are looking to become a medical biller, good training is crucial. When we have a new employee the training process is intense. It is important that the new employee learn how we do things, and become as self-sufficient as possible as quickly as possible.

Of course in the beginning mistakes are going to be made. We start out by having an experienced biller sit directly with the new employee and have the new employee watch what the experienced biller is doing while taking notes. The whole time, the experienced biller is explaining step by step what they are doing, why they are doing it, how they accomplish it, and every other detail that the new employee may need to know. They are also explaining our practice management system, our filing system, our system of receiving information, and how we communicate with our providers. There is so much to show them.

Once we feel that they have observed enough, the experienced biller switches places with the new person and gives them a chance to try things out for themselves. The amount of time that a new person watches before they are ready to try it varies greatly depending on their previous experience and how quick of a learner they are. Once they switch places the experienced worker watches every keystroke to make sure they truly understand. Many times they give verbal instructions the whole time until they are sure the new person has grasped the task.

Once they are able to observe without having to give verbal assistance they will allow the new worker to complete a task and then check it over after they are done. This is still time consuming as it's being done twice basically. But we feel it is necessary in order to be sure the new person is doing things correctly. The experienced worker will check over each item and bring any mistakes back to the new person and show them what they've done incorrectly. We find this is a great tool. Learning from visually looking at your mistakes is the best experience you can give someone.

As you can see the training process (at least in our office) is very intense and very disruptive to normal work flow. It takes two people to do the job of less than one really. The process is slow but if you want the person to be effective you need to take the time in the beginning to make sure they are trained properly. When we bring on a new person it is usually several months before they are up to speed and the person involved in their training can go back to their regular duties.

If you want your employees to be good quality employees then you need to take the time to train them. You can't expect them to give you excellent quality if you haven't taught them how to do that. We find that mistakes take a lot more time to correct on the back end than they do to avoid them up front. If you take the time to properly train the person, it will pay off in the end.