As a medical billing and coding specialist, you can benefit from a few “tricks of the trade”
Patients and medical offices alike owe a lot to medical billing and coding professionals. These detail-oriented billing “investigators” process the claims that go to insurance companies for reimbursement after a patient has received treatment. This helps to ensure that the patient does not pay out of pocket unnecessarily, and that the medical office receives the payment for services rendered.
Here are some strategies that can make this work easier for the health claims specialist. These suggestions offer ways to keep the large amount of work you’re likely to have running smoothly.
It can save you a lot of time and aggravation if you don’t wait to begin the process of assigning a code and submitting the claim form. Even though there’s usually a window of several days to complete this, it will serve you well to review the medical documentation soon after a patient’s visit, while the details are fresh in everyone’s minds (doctors, nurses, techs, and other staff). That way, if you have any questions, there shouldn’t be trouble in sorting them out. If it turns out there is missing information, or uncertainty in any of the details, you want to be able to jump on it right away. The more days that pass, the more of a challenge this can be. Do yourself a favor and stay on top of the list of patients you need to process each day.
Be familiar with payer guidelines
Make sure you know the terms of each payer, in terms of:
- requirements for billing procedures
- how long you have to submit a claim
- what procedures they cover
- when they require pre-authorization
- when they require referrals
- other details that are specific to that company only.
Keeping these items straight for each payer is good business, and makes it clear that you’re staying on top of your job (and not wasting their time).
Check every day on accounts receivable
You don’t want more than a day to go by when a payment is past due. If you stay on top of the reports about when payments are due, you can monitor those accounts that look like they might be in trouble. Then you can reach out to the insurer and do your best to bring the delay to their attention. You want to make sure that any delayed claim is already in process, and not stuck somewhere on its way to processing. Verify the claim number, and ask them when you can expect payment. It’s a good idea to ask for the name of the individual you speak to, so if you need to call again you can track the information they gave you the last time.
Track down checks that are “in the mail”
If a payer says they already made payment, but your office has not received it, ask for the following details:
- date when payment was made
- address they sent it to
- check number
- whether the check has been cashed.
That way you’re equipped to determine whether a stop payment needs to be made, and a new check issued.
Get to know the people who can help you
Your contacts at the insurance companies are your lifeline for sorting out these problems. It’s a great idea to get to know the people you’ll be speaking to on a regular basis. Making an effort to develop your relationships with them, so they know and trust you, will yield tremendous benefits. Don’t bother them until you’re absolutely sure you need their help—make sure there hasn’t been an error on your end before you pick up the phone or send an email. You want them to feel you’d never waste their time. This will make your interactions quicker and lead to more accurate information.
Everyone benefits when the medical billing and coding specialist does his or her job efficiently. We hope that these suggestions are useful to you as you are tackling your workload in the coming days and weeks. All of us in the healthcare field are grateful for your diligent work and attention to the details of our care!
This post is part of the Harris Casel Institute’s weekly blog. We care about and support all of our students, as they work towards their professional and personal goals. Visit our website for details about the career training programs we offer at our campus in Melbourne, FL.