While some college graduates face an uncertain future, the healthcare industry continues to grow, and opportunities for compassionate people with good organizational skills are plentiful. If you live on Long Island, you can become a medical biller in months with a technical school online program.
Medical billers manage financial tasks in healthcare facilities. As allied health professionals, they’re a critical link in the healthcare revenue cycle, the process by which healthcare providers are paid for their services. The work includes:
Filing Health Insurance Claims
Trillions in medical expenses are billed to insurance annually. Medical billers prepare paper and electronic claim forms, and work with providers, administrators and insurers to ensure prompt reimbursement.
The process involves gathering health data from patients’ medical records and translating it into short, alphanumeric codes that correspond to specific procedures, diagnoses, and treatments. Code condenses large volumes of information, making insurance claims more efficient to file.
Coding also creates a browsable database of health information that is used by medical administrators and public health agencies to track disease rates, monitor treatment utilization, and understand outcomes. It’s important work that helps facilities and the government control costs while addressing community healthcare needs.
Medical billers also attach supporting documentation, such as itemized statements or copies of medical reports, to claim forms. Once completed, claims are submitted to the patient’s insurance company, usually through a digital portal, for payment. The insurer will then process the claim, determine the amount of the payment and forward reimbursement directly to the healthcare provider or the patient, depending on the specifics of their insurance plan.
When claims are denied, medical billers investigate the cause. Most rejections come down to missing documentation or coding mistakes.
In a research-intensive process, medical billers review and correct errors before resubmitting claim forms. Attaching additional documentation proving the medical necessity of treatments may be necessary. Payment ultimately becomes the patients’ responsibility if subsequent claims and appeals are denied, so medical billers make every effort to satisfy the insurer’s requirements.
Requesting Prior Authorizations
Medical billers request insurance preapproval for services to ensure that recommended treatments are covered by the patient’s insurance plan. Called a prior authorization, it limits the patient’s financial liability if the claim is denied.
This pre-approval process also helps medical facilities avoid any unnecessary procedures or tests that may not be covered by the insurance plan. It’s an important step in the billing process that safeguards both the patient and the healthcare facility from unexpected costs. Most insurance plans have approval clauses for hospital admissions and high-value procedures.
Medical billers track payments received from patients and insurers, ensuring that each has paid their fair share. You’ll keep running tallies of balances owed until the full amount is paid.
Contract rates, multi-service discounts and other adjustments, such as fees on late payments, complicate the billing process. Most of it is processed automatically with billing software, but some light accounting is part of the job.
Medical billers play a critical role in recordkeeping by maintaining accurate billing information. They’re responsible for entering and updating patient demographics, insurance policy numbers and other relevant data into electronic health record (EHR) systems.
Medical billing involves several regulatory components, such as:
HIPAA Compliance – The Health Insurance Portability and Accountability Act (HIPPA) regulates how medical information can be shared. Medical billers must ensure that they comply with HIPAA regulations regarding informed consent and patient privacy. You’ll need to verify, for example, that the patient signed a consent form authorizing billing before submitting a claim on their behalf. And billing data must be kept secure, by law, it’s as confidential as health information.
Coding Standards – proper coding can increase a healthcare facility’s revenue, but the improper use of codes to increase medical bills is illegal. Medical billers must follow strict coding standards, ensuring that bills are submitted according to industry standards.
Fraud and Abuse Prevention – medical billers must comply with laws that prevent fraud and abuse in healthcare, such as the False Claims Act and anti-kickback laws. Services billed to insurance companies should be medically necessary and meet the coverage criteria outlined by the payer.
Billing and Collection Laws – healthcare providers are required by law to give patients clear and accurate information about the cost of medical services. This includes providing itemized bills and explanations of charges, as well as informing patients about their insurance coverage and any out-of-pocket costs they may be responsible for. The Affordable Care Act (ACA) also includes provisions to protect consumers from surprise medical bills and limit the amount that can be charged for out-of-network care.
The Fair Debt Collection Practices Act (FDCPA) outlines guidelines that debt collectors, including medical billers, must follow when invoicing patients. Many states have similar regulations governing debt collection practices.
Violations of any regulation can result in significant financial penalties for employers and termination for the employees involved.
Medical billers help patients navigate a complex billing experience by:
- Walking them through the claims process
- Requesting prior authorizations and negotiating with insurers on their behalf
- Explaining balances owed
- Investigating billing errors
- Answering general questions
Not all medical billing positions are customer-facing, but patients are always the focus.
How Do I Become a Medical Biller in Long Island?
Medical billing is an expansive field. Some billers have a bachelor’s degree while others have an associate’s or a technical school diploma. The latter is becoming more popular as students seek intensive vocational training that gets them out of the classroom and into the field faster. With an online program, you can take classes in the comfort of your own home with little commuter expenses.
How Long Is the Medical Biller Program?
Students can complete an online technical school program in just three months. The training is comprehensive but career-focused, preparing you for an entry-level position as a medical practice billing specialist.
What Are the Benefits of Attending an Online Technical School?
There are benefits to both on-campus and online learning. But online technical school programs have advantages that are too good to ignore, including:
Students spend time and money commuting to school, whether they drive or use public transportation. Online learning eliminates the budget strain of fuel, tolls, parking fees and vehicle maintenance. Not to mention the physical and mental exhaustion of being on the road when you have better things to do.
Lower Living Costs
Room and board fees at traditional colleges can be cost-prohibitive, adding thousands to what would otherwise be an affordable education. Studying from home is a more cost-effective option for most students.
Learn from Anywhere
Online training eliminates geographical boundaries, making it possible to access a wider range of educational opportunities without the need to travel. Not all medical billing programs are created equal, so students can choose the education that meets their unique training needs. Digital technology brings the classroom to you from anywhere.
Demonstrates Proven Technological Skills
Online courses rely on the same audio-visual technology that many businesses use for virtual communication or remote work. Graduating from an online program shows that you can effectively use digital equipment, a huge plus in a tech-heavy industry like healthcare.
Remote learning makes it possible for students to pursue their higher education goals despite busy schedules and life commitments. If time and distance are all that stand between you and a medical billing career in the Long Island area, an online technical school program is the solution.
Want to Learn More?
Did learning about the benefits of online medical billing and coding programs interest you? The Medical Billing Specialist program at Hunter Business School on Long Island prepares billing and coding students to obtain entry-level employment specializing in medical related billing and coding in physician’s offices. The online Medical Billing program is a 3-month diploma program available online.