The medical billing process is not a simple thing and therefore, the billing staff must have complete knowledge about things. He must either be an expert in the field or must have the relevant degree to do the job. The requirements are rather strict because it significantly affects the revenue of the company. That is why even fresh graduates need proper training.
In addition to this, medical billing workers must have the necessary certifications. They can take the CMRS, RHIA, CPB or other exams. These certificates are proof that they are well aware of the medical billing field.
If you are new to medical billing or you are interested in psychiatry and behavioral health, be sure to visit CollaborateMD.
Psychiatry and behavioral health are different from other fields and therefore, you should have in-depth knowledge about them. So if you are planning to learn about medical billing, you need to focus on the field. You must have a clear direction and the field that you are going into. Because coding and details about psychiatry are different from other medical fields.
But here are a few things that every biller must know. Or you can say a few tips that will help you out with your job.
1 – Learn to code
If you have chosen the professional for yourself, you must be prepared for what comes next. You need to remember the codes because incorrect coding results in a huge annual loss. An incorrect code on the bill results in the rejection of the claim. Therefore, it is a very important thing for a billing officer.
However, only experience and knowledge are not enough here. The codes might change with time or there might be new things. Therefore, medical facilities should make sure that they are offering timely training to their staff. If the staff is unaware of the new codes and regulations, your Medicare facility will lose its revenue.
Using incorrect coding is one of the common reasons for the rejection of claims. Untrained staff mistakenly use incorrect CPT codes and thus, it results in the wrong diagnosis. This ultimately becomes the cause of the rejection of the claim. Because insurance companies are not going to compensate for something that they have not mentioned in their contract.
So if you are an employee, you must keep your coding knowledge up to date. And if you are an employer, you must ensure timely training for your billing staff. This will keep them active and thus, results in fewer mistakes on their end.
2 – Identification of the provider
Who will provide the payment for the bills? Of course, a biller won’t know about this. Therefore, it is important to get the details from the patient or the patient’s family. If you use an incorrect provider, the claim will get rejected and the work will get doubled. That is why you must try your best not to make any mistakes in the very first step.
To make sure you identify the correct provider, you must get all the essential details from the patient. After confirming the details with the patient, you should send the bill to the insurance company for the claim. Though it sounds very simple, it is also one of the mistakes that result in a revenue loss annually. So even if it sounds silly, a worker can make such a mistake. Therefore, if you are working in this field, you need to be extra careful with the details.
3 – Pay attention to details
Insurance companies have a team of experts. They have a medical board that looks through the claims. Therefore, if you want to maximize your revenue, the main job is billers. The bills must be completely accurate and must not give any loopholes to the insurance companies.
Some of the common mistakes in details that result in rejection of the claim include;
- Incorrect information about the patient
- Name of the patient, his date of birth and insurance ID
- Incorrect information about the provider
- Address of the provider, his name and contact information
- Duplicate bills
- Not verifying whether the claim has already been made or the service has been reported
- Improper or poor documentation
- No details about the explanation of benefits on the claim
- Unclear or missing claim number references
These are the things that can cause confusion. There are people with similar names, the same date of birth, and many other similarities. Therefore, you should make sure that you do not make any mistakes in the details.
4 – Highly efficient performance
A medical bill worker must be highly efficient because this job is quite demanding. You need to quickly follow up on the cases and make sure of your availability. The billing department does not deal with a single party. They have to deal with the patients, their families and the insurance companies. Therefore, there must be proper coordination to ensure proper results.
Furthermore, you will be receiving emails and you have to respond to them. Similarly, there will be faxing letters and sending bills to the providers. In case of a mistake or wrong address, you will have to re-verify the details. Any delay from your side will delay the income of the physician and the revenue of the medical center. Therefore, a highly active mentality is required.
5 – Challenging denied claims
Although some silly mistakes can result in the claim denial, what next? You cannot just ignore the rejection. Therefore, if there was a mistake, you must correct it.
But there is another important thing that you should know. Despite being a flawless claim application, 3 to 4 percent of applications face rejection annually. Therefore, if your claim is denied, you must challenge the claim and ask for payment.
Likewise, there might be a problem with your process. So whatever it is, you can always challenge the denial. But review the process and details first and then challenge the denial.