The Many Hats of Medical Billers
As we celebrate Medical Billers Month, let’s acknowledge the critical role these professionals play in the healthcare system. They are not just billers – their diverse skill set is crucial to the success of healthcare providers as communicators, problem-solvers, technologists, and financial managers. Their work goes beyond processing claims; they ensure the financial health of healthcare providers and maintain the integrity of patient billing.
The role of medical billers often goes underappreciated in the healthcare industry. But they are key to the smooth operation of medical practices. Much of their work is behind the scenes, so let’s lift the curtain and take a look at the many hats a medical biller wears:
Communication with insurers…
Medical billers post patient payments, either manually or using software. They prepare claims, submitting them either by mail or electronically, requiring constant back-and-forth communication with insurance companies. They follow up with providers for missing information, coding clarifications, and diagnosis or modifier confirmations.
…and patients, and also with
Basic correspondence, e-mails, phone calls, texts – whatever it takes, the medical biller keeps patients in the loop on the status of their claim. They address inquiries about claim statuses, patient benefits, and eligibility. The better the communication, the more fully informed the patient feels – and the more satisfied they are.
…colleagues.
As the go-to person for communication between insurers and patients, fellow employees know who to ask to get the latest status for claims and many other general inquiries: the medical biller.
Keeping data up to date
Interactions with insurers and patients alike must be recorded in the task management system. The medical biller captures patient demographics and enters charges from fee slips into practice management (PM) systems.
Financial health hinges on medical billers
Medical billers are responsible for posting patient payments manually or via software. They also prepare and submit claims and mail them or send them electronically to clearinghouses. This meticulous work involves constant communication with insurance companies and handling everything that comes back from them.
Many medical billers handle collections and manage credits. This includes auditing for overpayments and dealing with unclaimed funds, a crucial aspect of compliance and financial integrity.
On top of all this, they prepare and deliver bank deposits and enter payments from insurance carriers into the system to reconcile patient records.
Claims management – the devil is in the detail
Managing claims means verifying eligibility and following up on claim statuses in time to meet the filing deadline. Medical billers must often multitask, especially during long hold times when calling insurance companies for more information.
And if a claim is denied? This is when the medical biller rolls up their sleeves and gets into the nitty-gritty details. Working on denials can take up to half the day, but this task is key. Denials can severely impact accounts receivable and are the equivalent of practicing “preventative medicine” in the billing process. Medical billers also prepare appeals and reconsiderations.
Technology is a medical biller’s best friend
Medical billers navigate back and forth between multiple systems for task management, billing, online banking, and others. Being tech-savvy is a basic requirement to do the job.
How can you make a medical biller’s job easier?
When the job requires everything, everywhere, all at once – how do you keep track? The good news is that there are many tools and processes available to make the job both easier and more efficient.
Here are some practical ideas:
Beef up technology: Invest in advanced software for direct claim submissions and/or establishing better liaison protocols. This can massively reduce the time needed for communicating with insurance companies, e.g., by eliminating lengthy hold times.
Improve processes: Regularly review fee schedule agreements. A proactive approach keeps insurance companies and medical billers on the same page and can reduce or even eliminate conflicts and delays.
Practice recognition and respect as part of your work culture: Openly recognize the medical biller’s role as integral to the healthcare process. Encouraging a culture of respect and cooperation can significantly improve the work environment not just for medical billers but for all staff.
Establish a clear policy of ethical billing: Clear guidelines and a supportive system for ethical billing protect everyone involved. Medical billers must never be pressured to engage in unethical billing. Apart from being unethical or illegal, it causes stress.
Train medical billers and other staff: Give medical billers the right training and support to do their job well. Assign a mentor and provide ongoing education opportunities to enable them to keep their skills up to date. Educate all employees on the importance of medical billing so they understand its complexities and the importance of collaborative efforts.
Stay on the lookout for new technology – and embrace it: Keep abreast of changes in technology in the healthcare sector – and use them to your advantage. Encourage a mindset of adaptability and openness to new, more efficient billing methods and technologies. This will keep your practice up to date.
These strategies can ease the workload and challenges faced by medical billers, improving their work life and enhancing the efficiency and effectiveness of your medical practice.
The Unsung Heroes of Healthcare
Let’s recognize the immense value that medical billers bring to their organizations. It’s crucial to support and appreciate these professionals who contribute significantly to the healthcare industry.
