Did you know that hospitals and patients deal with over 1,600 insurers, each with a different plan and unique requirements for hospital bills? Medicare rules and regulations comprise 130,000 pages, which a medical biller must understand to submit bills for payment. This can make processing hospital bills difficult. The good news is that the Medical Office Administration program at Hunter Business School can prepare you for this complex task.
Physician Billing vs Hospital Billing
These are two different types of medical billing processes.
What is Physician Billing?
Physician billing, also known as Ambulatory Surgical Center (ASC) billing, is less complex because it focuses on limited services offered by a small group of physicians. These include medical bills to claim payment for medical services from a physician or healthcare provider to a patient with medical insurance. This can consist of inpatient and outpatient services billed after patient verification. Many physician services are offered on a fee-for-service basis, where the physician’s office is paid a set amount for services rendered.
What is Hospital Billing?
Hospital billing is more complex because of the abundance of medical services offered. Federal law requires hospitals to maintain uniform charge structures. Hospital billing can include medical services billing from laboratory services, medical equipment and supplies, and other hospital services. Some hospitals outsource their medical billing to avoid errors and payment loss. Many hospitals are paid at a case rate and a set amount for each day of care. Hospitals are more likely to bill Medicare or Medicaid than a physician’s office.
What are the Laws & Regulations of Hospital Billing?
There are many laws and regulations that improve hospital billing for patients. Medical billers can educate patients about their medical rights. These laws and regulations make medical service fees affordable, transparent, and accessible.
Patient Protection and Affordable Care Act (ACA)
This law provides rights and protections that make health coverage more fair and affordable. The ACA requires insurance plans to cover people with pre-existing conditions, to provide free preventive care, to end lifetime and yearly out-of-pocket limits, and to protect a patient’s choice of doctor.
No Surprise Medical Bills
This law removes surprise medical bills from patients who use out-of-network providers. It bans surprise bills after receiving emergency care and requires the costs to be shared with the patient upfront before services are rendered.
Medicare
Medicare is for seniors 65 or older, those with disabilities, and people with end-stage renal disease. Medicare Part A covers inpatient hospital stays, hospice care, and some home healthcare. Medicare Part B covers doctor’s services, outpatient care, medical supplies, and preventive care. Medicare Part D covers the cost of prescription drugs.
What Does a Medical Biller Do with Hospital Bills?
Medical billers have many responsibilities to manage hospital bills for patients. Some of the everyday tasks include:
Answer Patient and Insurance Inquiries
It is the medical biller’s responsibility to answer patient and insurance inquiries. Patients will contact the medical biller with questions about their bills, arrange payment plans, and submit payment for medical services. The medical biller will also be contacted by the insurance company with inquiries for information about claims.
Review Patient Bills for Correctness and Completeness
An essential part of the medical biller’s job is to review patient bills. Medical errors can cause patients to pay out-of-pocket expenses, so medical billers ensure patient bills are correct and complete before they are reimbursed.
Collection Accounts
It is the medical biller’s responsibility to send out payment reminders and collect payments for patient services. Medical billers may also need to submit late payments to collections or help patients set up a payment plan.
Gather Referrals and Pre-Authorizations for Doctor’s Procedures
Many medical billers will get pre-authorization for hospital services before completion to reduce the number of rejected claims and lost revenue. This helps hospitals get appropriate reimbursement for patient services.
Verifying Eligibility of Benefits for Treatment
The medical biller will verify that a patient’s insurance will cover treatments and offer upfront transparency under the “No Surprise Medical Bills” Act. This also ensures the hospital doesn’t have to pay for an outstanding patient bill.
Submit Claims
Medical billers submit claims on the patient’s behalf to insurance companies and Medicare for hospital services rendered. The claim process can be complex, and medical billing and coding errors can cause claims to be rejected.
On average, 17% of in-network claims are denied. This is mainly a result of medical billing and coding errors. Information may be incorrect or incomplete on insurance claims. This leaves patients to pay out-of-pocket and possibly incur medical debt. It is the medical billers’ job to properly code insurance claims so that medical services are paid for.
Investigate and Appeal Rejected Claims
When an insurance claim is rejected, it is the medical biller’s responsibility to review the denial and investigate the cause of the rejection. If they find an error or believe an algorithm denied the claim without cause, the medical biller will appeal the rejected claim with the insurance company or Medicare.
Final Thoughts
Do you want to be a part of the healthcare industry but not in a clinical capacity? As a medical biller, you still get the reward of helping others. It’s the best of both worlds. Let Hunter Business School prepare you for an entry-level role as a medical biller.
Want to Learn More?
Hunter Business School graduates of the Online Medical Office Administration training program can obtain entry-level employment as a medical office specialist or patient coordinator in a hospital, clinic, or physician’s office. Additional possibilities include a billing, admissions, or health unit coordinator in private firms, medical offices, legal offices, or government organizations. The online Medical Office Administration program is a 5-month diploma program available online.
Contact us today to learn more about becoming a medical biller on Long Island.