Doctors have a language of their own and as a medical billing specialist, you must keep up. Even without a background in healthcare, you can learn to decipher the jargon like a pro. A medical billing specialist program with a course in medical terminology will show you how.
Why Is Medical Terminology Important for Medical Billing Specialists?
Medical billing specialists manage insurance claims for healthcare providers. Terminology touches every aspect of their jobs. Claims are not just contingent on the services rendered, but on why they were provided and for what diagnosis. Let’s take a closer look at what medical billing specialists do and how terminology affects every aspect of their job.
Submitting Insurance Claims
Nearly all medical bills in the US are paid for by a third party, a private insurer or a government program like Medicare or Medicaid. Claims aren’t paid unless forms contain the data necessary to ensure that services were medically necessary and covered by the patient’s policy. As a medical billing specialist, you’ll have to sort through a patient’s charts to find answers, reading through doctor’s notes, laboratory results, and post-operative reports. You’ll run across complex terms that you’ll need to identify quickly and accurately.
Appealing Rejected Claims
A substantial number of insurance claims are initially rejected, often for transcription errors, but usually because of insufficient information. In some cases, insurers want to know more about when and why services were rendered to determine if they’re covered. Most claims must meet several criteria.
For example, some policies pay for preventive services, such as lab tests for high cholesterol. It’s an important part of assessing a patient’s risk for heart disease and allows for early intervention. Others, however, limit the number of times so-called screening tests can be performed.
If the doctor orders it too soon, it may be the patient’s responsibility to pay.
If reimbursement is denied, it’s up to the medical billing specialist to investigate, cross-referencing policy requirements with information in the patient’s chart to get disputes solved quickly. Maintaining steady cash flow is essential for the practice or facility, and few patients can afford to pay hefty bills while claims are still pending.
Obtaining Preauthorization for Services
The simplest way to prevent rejected claims is to submit a request for preapproval before services are rendered. Since most medical information is now shared electronically, it’s a quick and easy process.
Similar to a claims form, the medical billing specialist submits requested information and awaits approval. The research process is similar to filing initial claims and requires considerable information gathering.
Insurance companies demand large volumes of information to determine if claims are covered. If that data weren’t somehow condensed, claim forms would be chapters long. It’s not practical.
Instead, medical billing specialists convert information into medical codes; short, alphanumeric sequences that describe everything from symptoms and diagnoses to diagnostic tests and surgical procedures. In some cases, codes allow algorithms to make quick coverage decisions, if the information is accurate. It requires a good grasp of medical terminology. Coding systems include:
ICD-10 – an abbreviation for the International Statistical Classification of Diseases and Related Health Problems, 10th Revision. Used by healthcare systems worldwide, it classifies every symptom, injury or condition known to the scientific community.
When completing claim forms, codes describe the symptoms or malady for which services were provided. It’s one way insurance companies ensure they don’t pay labor and delivery fees for a patient with a broken arm. Medical billing specialists do the bulk of the coding in most medical facilities.
CPT – Common Procedural Codes, are five-digit numbers classifying medical, surgical, and diagnostic procedures. Developed by the American Medical Association (AMA), they’re used on claim forms and to report medical outcomes to watchdog agencies.
HCPCS – Healthcare Common Procedure Coding System, is an alphanumeric coding system developed specifically for Medicare. It consists of three levels. Level I is the CPT index. Level II categorizes medical equipment, certain drugs, and ancillary services. Level III codes cover services or procedures not listed in levels I or II.
Billing for Non-Covered Balances
Few insurance policies cover 100-percent of medical bills. They’re usually subject to deductibles, co-insurance, and exclusions. After claims are paid, medical billing specialists invoice patients for the remaining balance, so it’s vital to understand which services weren’t covered and why. It requires understanding both medical terminology and insurance-speak, both of which vocational schools teach.
How Do Medical Billing Specialists Learn Medical Terminology?
The fastest way to learn medical terminology is by enrolling in a vocational school program. A foundation for the rest of your classes, it’s one of the first courses you’ll take.
As a student, you’ll learn to decipher terms by identifying their parts, prefixes, suffixes, and root words, so you can interpret the information found in medical charts.
Here’s how it works. Consider the term “Benign Prostatic Hyperplasia.” The word benign, meaning non-cancerous, comes from the Latin root bene meaning “well.” The word prostatic refers to the male prostate gland. Hyperplasia is a combination of the prefix “hyper,” meaning excessive, and the suffix “plasia,” meaning the growth of cells. So even if you don’t know exactly what Benign Prostatic Hyperplasia is, if you assumed it’s a non-cancerous overgrowth of cells in the prostate gland, you’d be right.
While anyone can memorize medical terms without taking a formal class, it’s easy to forget the definition of words you don’t use daily.
But a medical terminology course equips you to figure out what words mean in relation to diagnoses, medications, procedures, and supplies. Combined with instruction in anatomy and physiology, it’s all students need to feel well-prepared as entry-level medical billing specialists. With a good start, the process gets easier with experience.
What Else Do Students Learn in a Vocational School Medical Billing Program?
Graduating from a vocational training program is the shortest path to a more secure career as a medical billing specialist. In addition to medical terminology, you’ll learn about:
Medical Office Procedures
Healthcare is highly regulated, so office procedures are different than at the average business. Geared for beginners, vocational programs cover administrative procedures from filing and mail handling to electronic communication and inventory management. You’ll get a complete overview of how medical offices operate and what your role will be like as a medical billing specialist.
Anatomy and Physiology
Medical billing specialists have no clinical responsibilities, but as with terminology, knowing how the body is made and how it works helps you better understand documentation. Anatomy and physiology courses cover the basics, so you’ll feel confident researching medical records.
Electronic health records are stored digitally. You’ll practice on retrieving and entering data accurately on a computer while learning about patient privacy and record security.
Billing and Insurance
Medical billing is part of the revenue cycle, the complex way in which healthcare bills are paid. In this course, you’ll learn about the many public and private insurance options, including government programs such as Medicare, Medicaid, military insurance, and worker’s compensation.
Benefits of a Vocational School Medical Billing Program
The benefits of taking a vocational school program don’t end with a quality education.
Benefit #1: Flexible Schedules
Vocational schools know some students have challenges, so they offer lifestyle-friendly options, including full-time, part-time, and evening classes. You can earn while you learn, taking courses at your own pace, or graduate as soon as possible by attending full-time.
Benefit #2: Small Class Sizes
Smaller classes make higher education less intimidating. The atmosphere is relaxed, and it’s easier to focus, you’re not just a face in a crowded lecture hall. Everyone works together, and no one falls behind.
Benefit #3: Career Services
Medical billing specialists are in demand, but new graduates still must compete for the best jobs. If you’re qualified, finding work isn’t hard, but landing a position you’ll be happy in long-term is more challenging.
Vocational schools work hard to ensure their graduates get good jobs. Partners to local businesses, they’re go-to sources for medical facilities that need staff and are often aware of employment opportunities that aren’t publicly posted.
Healthcare is both an art and a business. Hospitals, clinics, and private practices need to recoup money promptly for their services or else they and the communities they serve lose out. Medical billing specialists aren’t direct caregivers, but they’re just as much a part of the healthcare team. It’s a rewarding and meaningful role.
Did learning about using medical terminology as a medical billing specialist interest you? Are you ready for a rewarding career as a medical billing specialist? 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, clinics, medical insurance companies, and hospitals. The Medical Billing Specialist program is a 3-month diploma program available in the evening.