A normal day in the life of a Medical Biller


Are you aspiring to be a medical biller some day? Medical billing is certainly an interesting job, but coding way back in 1996 was much simpler than what it is now. Every year the billing industry undergoes numerous changes and much more sophisticated work. These professionals need to stay updated every now and then to operate smoothly.

To be a medical biller and coder, one requires executing many tasks throughout the day.  After a patient receives treatment from the doctor, billers are responsible for billing the patient’s insurance company. Each treatment is assigned a specific code and is entered into a special software system. This code tells the insurance companies exactly what the reimbursement nature is, allowing the billing and payment process to run efficiently and quickly.

What does a medical biller entail?

  1. Code patients’ medical information for reimbursement
  2. Ensure insurance companies are being billed properly
  3. Troubleshoot with insurance companies
  4. Use classification systems software to assign codes
  5. Communicate with doctors’ offices, clinics, and hospitals

Perhaps, taking a close look at the everyday schedule of a medical biller will help you understand what job, environment, and responsibilities are required for these professionals.

A medical biller usually works 40 hours per week and spends most of the time in front of a computer entering codes, and processing billing information. He should possess good communication skills in-order to communicate effectively with the insurance companies.

A biller’s basic task would be generating and transmitting insurance claims. With software at its disposal, this task has become even simpler. Although, every software has different functionalities, the basic setup is the same.  This features a screen where you enter the patient’s details, including name, phone, address, policy number, injury or illness date, the diagnosis and procedure codes and the doctor’s fees and charges.

When you first take on the practice, you’ll spend a huge amount of time entering all the doctors and patients in your software program. Although this consumes a lot of time, it’s worth the effort since it will ease to retrieve the data you will need on file. You can find the CPT (for Current Procedural Terminology) and ICD-10 (for International Classification of Diseases) codes on the super bill.

CPT coding process are discussed and revised every year, hence you ought to stay updated with all the latest updates. When you are with a new client, grade his/her super bill. Check if the bill is coded in the latest ICD-10 coding specified for that practice.

If by any chance a claim gets denied, check for the following reasons:

. If diagnosis is provided

. Is there any inconsistency in the service or procedure rendered?

. Is the diagnosis justifying the level and need of service provided?

. Confusing multiple diagnosis are given

The first two problems are pretty simple to look at but make sure the diagnosis is fair and accurate with the procedure listed. For problem number 3: If the diagnosis doesn’t justify the procedure listed, then the doctor has failed to code for the excusing circumstances. The problem number 4 can be solved with a careful observation on your part. Some doctors over-diagnose their patients for the purpose of billing and use three to four ICD-10 codes to justify. This creates confusion in the mind of the claims examiner who then tries to review and examine the statement and its payment. Avoid such tendencies as it can land you in trouble for reimbursement.

Handling collections

Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), all the entities covered by HIPAA require to submit claims electronically. Note that HIPAA does not expect all the practitioners to conduct all transactions electronically. Transactions that are listed under the HIPAA must be completed electronically.

Your software readily produces your claims, ready for online delivery. The clearing house collects all the claims and routes them to the respective insurance carriers. It also reconfigured data in whatever format your carrier requires. The clearing house, to your surprise, also checks for errors and omissions before sending it out.  When it finds an error, it redirects the claim back to you so that you correct it.

The final phase of the process is to ensure those bills get well paid. Billers are in charge of mailing out timely, precise bills, and then following up with patients whose bills are delinquent. If you have not received the payment even after 45 days, it’s time to find out what went wrong. If you find any mistakes in your submissions, try and correct them as early as possible.  Add a note specifying the error and, if necessary, additional documentation to support your correction.

When you receive a patient’s Explanation of Benefits (EOB), start grading the insurer’s work. Compare the charge amount listed with the charge amount in your patient’s account ledger.

Once a bill is paid, the information is stored in the patient’s file. Smaller offices like medical billing providers also hire medical coders. In these cases, you might be the only coder, but you will certainly enjoy the chance in getting to know other office staff as well as the regular patients.