Module 1 Role of an Insurance Billing Specialist
docx
School
UEI College, Gardena *
*We aren’t endorsed by this school
Course
MEDICAL BI
Subject
Health Science
Date
Jan 9, 2024
Type
docx
Pages
14
Uploaded by ConstablePigeonPerson975
Module 1: Role of an Insurance Billing Specialist
Module 1 Overview
1.
Physicians and other health care providers need employees who:
a.
Understand the complexities of insurance claims
b.
Handle day-to-day medical billing procedures efficiently
2.
Medical billing and coding is a field that is expected to grow much faster than average due to this demand
3.
Insurance Billing Specialists:
a.
Primarily concerned with ensuring the facility or provider is paid for services rendered
b.
Can involve:
i.
Verifying insurance coverage
ii.
Generating and submitting insurance claims
iii.
Bookkeeping/accounting
iv.
Registering patients
v.
Scheduling appointments
c.
In most cases, these tasks require specialized training from an accredited program
4.
Insurance Billing Specialists must:
a.
Behave according to proper medical etiquette
i.
Also ethical guidelines
b.
Be careful to perform actions only as permitted within the context of their employment
Lesson 1: Background of Insurance Claims, Coding and Billing
Lesson 1 Introduction
1.
A patient went to the doctor who told them what might be wrong
a.
The doctor then billed the patient
b.
The patient paid the bill
2.
A patient who needed hospital services:
a.
Probably received a single bill from the hospital that included the services of the physician
3.
Professional Insurance Billing Specialists:
a.
Are relied on by physicians and health care organizations
i.
As medical billing has become more complicated
1.2 Objectives and Reading Assignment
1.3 Revenue Cycle
1.
Revenue Cycle
a.
The functions required to capture and collect payment for services provided by a health care organization
i.
This is the Medical insurance billing specialists’ primary goal to assist in
b.
Revenue:
i.
The total income produced by a medical practice or health care organization
c.
Cycle
i.
A regularly repeating set of events
2.
The Insurance Billing specialist aims to both help:
a.
The patient:
i.
To obtain the maximum from their insurance plan benefits
b.
Ensure monetary flow to the health care organization
1.4 Medical Billing Complexities
1.
The health care industry has gone through changes which have made medical billing more complex:
a.
The health care industry is heavily regulated;
b.
Compliance with all federal and state laws is essential
2.
There are numerous payers, each with their own guidelines for billing
3.
Patient conditions and services must be coded which requires a special skillset
4.
There are various reimbursement methodologies which add to the complexities of obtaining maximum payment for services
5.
Healthcare organizations have transitioned from paper medical records to electronic records
6.
The Insurance Billing Specialist MUST:
a.
Have strong computer skills
b.
Learn to use medical billing software programs
c.
Become skilled in the use of electronic records
7.
Medical records:
a.
Refer to patient charts, which includes:
i.
Notes
ii.
Information collected by and for health care providers
8.
Health records:
a.
Refer to information collected from all health care providers who are involved in the patient’s care
b.
Authorized access to health records allows providers to:
i.
View all of the patient’s medical records
ii.
Make better informed decisions and treatment plans
9.
Personal health records
a.
Designed to be set up, accessed, and managed by the patient
1.5 Billing Types
1.
There are two types of billing:
a.
Facility Billing:
i.
Performed in:
1.
Hospitals
2.
Skilled nursing or long-term care facilities
3.
Rehabilitation centers
4.
Ambulatory surgical centers
b.
Professional billing
i.
Performed for:
1.
Physicians
2.
Nonphysician practitioners (NPPs)
a.
Also known as: Physician extenders:
i.
Professionals such as:
1.
Nurse Practitioners (NPs)
2.
Certified nurse anesthetists
3.
Physical therapists
4.
Speech therapists
5.
Licensed clinical social workers (LCSWs)
6.
Physician Assistants (Pas)
3.
Ambulance services
4.
Imaging and laboratory services
1.6 Health Care Organization Office Procedures
1.
The basic setup of a health care organization encompasses the following work units/departments:
a.
Reception of the patient
b.
Rendering of medical services
c.
Documentation of the services
d.
Financial accounting
2.
The flow of information between departments is one of the most vital components of an organization
3.
As an Insurance Billing Specialist, you must understand:
a.
Each department in relation to the business office
b.
How the functions in each area affect the revenue cycle
1.7 Scheduling
1.
The first part of patient reception is scheduling appointments
a.
Assigning time slots for patients visits or encounters
2.
Encounters:
a.
An interaction between a patient and a health care provider
i.
For the purpose of providing health care services; OR
ii.
Assessing the patient’s health status
3.
Health care workers who perform this function try to align the patient’s needs with the time available from their providers
a.
They can also cancel and reschedule appointments as needed
4.
How does scheduling affect the revenue cycle?
a.
If a patient’s appointment time is not properly assigned:
i.
There may be too many or too few patients at a given time
ii.
Results in inefficiency
1.
May reduce revenue
b.
Scheduling staff record:
i.
The reason for the patient’s visit
1.
This is important for the billing claim
1.8 Patient Registration
1.
Patient information form:
a.
A questionnaire completed by the patient
b.
Gathers all the patient’s important identification and contact information such as:
i.
Name
ii.
Date of birth
iii.
Address
iv.
Phone number
2.
Patient registration personnel also gather:
a.
Financial information:
i.
The patient’s payer
ii.
The payer’s identification numbers
iii.
Contact information
iv.
Other information concerning financial responsibility
3.
How does patient registration affect the revenue cycle?
a.
This is the time when important data about the patient and payer(s) are gathered
b.
Incorrect information would affect the information the business has on file
i.
As well as the submission and payment of claims
1.9 Documenting Patient Care
1.
Physicians, NPPs, nurses and others render clinical services to the patient
2.
The providers and clinical staff document the care and services provided to the patient as: NOTES
a.
Notes in the patient’s health record include:
i.
The reason for the visit
Your preview ends here
Eager to read complete document? Join bartleby learn and gain access to the full version
- Access to all documents
- Unlimited textbook solutions
- 24/7 expert homework help
ii.
History
iii.
Physical examination
iv.
Diagnostic tests
v.
Results
vi.
Diagnosis
vii.
Plan of treatment
b.
Both the patient’s diagnosis (or diagnoses) and any services rendered are assigned medical diagnosis and procedure codes
c.
Medical coding is used to represent:
i.
Diagnoses
ii.
Procedures
iii.
Equipment
iv.
Drugs
v.
Other aspects of health care
d.
These codes allow providers and payers to communicate in a standardized way about the care the patient received
3.
The Insurance Billing Specialist may be required to:
a.
Contact the insurance company to obtain authorization for treatment
b.
Ensure that forms are properly completed
c.
Data is input into the system
4.
How does documentation affect the revenue cycle?
a.
The importance of complete and accurate clinical documentation cannot be understated
b.
Neither the facility nor health care professionals will be reimbursed for services that are not performed and documented according to payer guidelines
1.10 Activity: Catch That?
1.11 Posting Charges
1.
Charge Entries
a.
The services rendered that are entered into the patient’s financial account
b.
Each charge entry is posted or entered into the computer system
2.
The Insurance Billing Specialist must make certain that the correct diagnosis code is associated with each service
a.
Ex: A patient who saw the provider for back pain shouldn’t have a service code for a flu test
3.
Posting charges also requires:
a.
Careful attention to the patients:
i.
Name
ii.
Date of service
1.
To ensure the correct charges are posted to the correct patient’s account
4.
How does posting charges affect the revenue cycle?
a.
Timely billing and reimbursement depend upon accurate charge entry
1.12 Bookkeeping and Accounting
1.
Payments received are posted to the patient’s financial account
a.
Just as charges are posted
2.
Payments may come from the patient or from the payer
a.
Sources of funds include:
i.
Cash
ii.
Checks
iii.
Electronic funds transfer
iv.
Debit
v.
Credit cards
3.
Account balance may also change because of:
a.
Adjustments
b.
Denials
c.
Write-offs
4.
The Insurance Billing Specialist will investigate when these appear to ensure they are legitimate:
a.
Adjustments
b.
Denials
c.
Write-offs
5.
How does bookkeeping and accounting affect the revenue cycle?
a.
Accounting records show:
i.
The amount owed to the health care professional or organization
b.
They are the primary means of tracking the financial health of the business
1.13 Activity: Matching: Office Procedures
1.
Documenting
a.
Assigning diagnosis and procedure codes
2.
Posting Charges
a.
Entering patient information and services into the computer system
3.
Patient Registration
a.
Collecting personal and insurance data
4.
Bookkeeping/Accounting
a.
Posting payments received to patients’ accounts
5.
Scheduling Appointments
a.
Assigning time slots for patients’ visits
1.14 Lesson 1 Conclusion
Lesson 2: Role of the Insurance Billing Specialist
2.1 Lesson 2 Introduction
2.2 Objectives and Reading Assignment
2.3 Job Titles
1.
Medical billing personnel work under various job titles
a.
Many are called Insurance Billing Specialists
2.
Depending on the employer, this professional may be known as:
a.
Electronic Claims Processor
b.
Medical Biller
c.
Reimbursement Specialist
d.
Medical Billing Representative
e.
Senior Billing Representative
3.
Billing departments in large health care organizations may have highly specialized positions, with
titles such as:
a.
Medicare Billing Specialist
b.
Medicaid Billing Specialist
c.
Coding Specialist
d.
Insurance Counselor
e.
Collection Manager
f.
Revenue Cycle Manager
2.4 Positions Outside the Health Care Facility
1.
Insurance Billing Specialists may work for insurance companies as claims exmaniners
a.
Claims Examiners:
i.
Analyze and process the claims sent by health care providers
ii.
They ensure the claim is valid
iii.
The services rendered meet reimbursement guidelines
2.
An Insurance Billing Specialist may find a job working for a Management Services Organization (MSO)
a.
Management Services Organization (MSO):
i.
Contracts with the provider or facility to perform a range of administrative functions
ii.
They may handle:
1.
Billing
2.
Coding
3.
Collections
4.
Payroll
5.
And more
3.
Claims Assistant Professional (CAP)
a.
Works for the patient
b.
Files claims and negotiates with payers to obtain maximum benefits
2.5 Job Responsibilities
1.
The main responsibilities of an Insurance Billing Specialist:
a.
Collecting reimbursement for services rendered by:
i.
Hospitals
ii.
Clinics
iii.
Other facilities
iv.
Health care professionals
2.
The person in this position should be able to perform any and all duties assigned pertaining to the business office
3.
The business office comprises both front- and back-office personnel
a.
They work together to complete the revenue cycle
b.
Front office:
i.
Patient-facing
c.
Back-office personnel:
i.
Work “behind the scenes”
2.6 Front Office Responsibilities
1.
Front desk staff are responsible for:
a.
Collecting payment
2.
Commonly, the patient owes a copayment at each visit before they are treated
a.
They also collect payment from self-pay patients
i.
Those who do not have an insurer or other payer
ii.
Therefore liable for the entire bill
3.
In some health care organizations, an Insurance Billing Specialist may act as an Insurance Counselor:
a.
Insurance Counselors:
i.
Take the patient to a private area of the office before being seen by the provider
ii.
Discuss the practice’s financial policies
iii.
Review the patient's insurance coverage
iv.
Help to obtain the payment in full
1.
When expensive procedures are necessary
Your preview ends here
Eager to read complete document? Join bartleby learn and gain access to the full version
- Access to all documents
- Unlimited textbook solutions
- 24/7 expert homework help
2.
Ensure that the health care organization will be paid for services rendered
2.7 Back Office Responsibilities
1.
After the patient is treated, documentation is finalized and reviewed
2.
A Coding Specialist may:
a.
Review diagnostic and procedural coding
i.
To ensure that the codes are supported in the clinical notes
ii.
That these codes are correct
3.
The codes are entered on the claim
a.
The provider most often sends to the payer on behalf of the patient
b.
The Insurance Billing Specialist must submit insurance claims PROMPTLY:
i.
Ideally, within 1-5 business days
ii.
This is to ensure continuous cash flow
c.
Cash flow:
i.
The amount of money generated and available for use by the health care organization within a given period
4.
In some organizations the Insurance Biller may act as a collection manager.
a.
In this capacity, the Billing Specialist:
i.
Answers routine inquiries related to account balances
1.
And insurance submission dates
ii.
Assists patients in setting up a payment schedule that is within their budget
iii.
Follows up on delinquent accounts
iv.
Traces claims that are:
1.
Denied
2.
Adjusted
3.
Unpaid
5.
Federal and State payers require the health care organization to file claims on behalf of the patient
a.
Some private payers do not have that requirement
b.
That provider usually files claims for the patient as a courtesy
2.8 Accounts Receivable Responsibilities
1.
All tasks are associated with management of the health care organization’s accounts receivable
a.
Whether they are on the front or back end
b.
Accounts Receivable:
i.
Represents the total amount of money owed to the health care organization for the services they have provided to the patients
2.
It is the responsibility of the Insurance Billing Specialist to:
a.
Develop the skills that will ensure the information on claims is verified as 100% correct
b.
That claims are sent out timely
c.
They follow the appropriate guidelines for submission
d.
Claims are complete
3.
A successful health care organization is one who:
a.
Follows the appropriate billing guidelines and processes
b.
Has a constant cash flow
c.
High revenue
d.
Low accounts receivable
2.9 Educational Requirements
1.
Typically, a postsecondary certificate or an Associate’s degree is required to enter the field of insurance billing
a.
To enter a certificate, associate, or bachelor degree program, an individual needs a high school diploma or its equivalent
2.
Course instruction includes the following:
a.
Human anatomy and physiology
b.
Medical terminology
c.
Claims completion
d.
Diagnostic and procedural coding
e.
Health care reimbursement
f.
Law and ethics
g.
Computer applications
h.
General office skills
3.
The program you choose should be accredited:
a.
It meets educational standards as determined by an independent accrediting body comprised of education and industry professionals
4.
A certificate program usually takes 1 year to complete
a.
An associate’s degree is a 2-year program
b.
A bachelor's degree is a 4-year program
2.10 Training Requirements
1.
Externship:
a.
A training program with private businesses that gives students brief practical experience
in their field of study
b.
Many programs offer this
2.
After training, to reach a professional level of billing or coding expertise:
a.
Certification is available from many national associations
b.
Depending on the type of certification desired
3.
Becoming self-employed requires:
a.
Work experience
b.
A deeper knowledge of the industry
c.
Commercial insurance payers’ requirements
d.
Medicare policies and regulations
e.
State Medicaid policies and regulations
f.
Proficiency in running a business
i.
Marketing
ii.
Sales expertise
2.11 Career Advantages
1.
The number of jobs in health care continues to increase faster than average
a.
Due to the increased demand for health care services as the population ages
2.
Health Insurance Billing Specialists are needed in an array of settings:
a.
Hospitals
b.
Medical offices
c.
Insurers
d.
Medical clearinghouses
3.
As you advance, you may find work as a:
a.
Consultant
b.
Educator
c.
Consumer advocate
d.
And more
4.
In addition to strong demand for employment and a healthy job outlook, the Insurance Billing Specialist career offers other advantages:
a.
Flexible hours
i.
The nature of the job offers opportunities to:
1.
Come in early or work late into the night
a.
This depends on the tasks and your preferences
2.
Medical billing positions have various combinations of work flexibility such as:
a.
Telecommuting
b.
Part-time
c.
Contract
d.
Work-at-home opportunities
b.
Opportunities for disabled workers
i.
A career as an Insurance Billing Specialist or a Collector of Delinquent Accounts can be rewarding with persons with disabilities
ii.
Telecommunications and other technological aids make the job appropriate for:
1.
Visually-impaired persons
iii.
Work from home can be appealing to those with physical disabilities
c.
Self-employment
i.
With experience, many people establish independently-owned businesses
2.12 Qualifications, Attributes and Skills
1.
The successful Insurance Billing Specialist possesses numerous attributes and skills, but the following list is by no means complete:
a.
Critical thinking skills
b.
Reading comprehension
c.
Problem solving skills
d.
Organizational skills
e.
Detail-oriented
f.
Curiosity
g.
Time management skills
h.
Social skills
2.
The Insurance Billing Specialist should also have a knowledge base that includes:
a.
Medical terminology, including:
i.
Anatomy
ii.
Physiology
iii.
Disease
iv.
Treatment terms
v.
Meanings of abbreviations
b.
Expert use of procedural and diagnostic code books and other related resources
c.
Precise reading skills
d.
Basic mathematics
e.
Knowledge of medicolegal rules and regulations of various insurance programs
f.
Compliance with:
i.
Federal privacy
ii.
Security
iii.
Transaction rules
iv.
Fraud
v.
Waste
vi.
Abuse
g.
Basic keyboarding and computer skills
h.
Proficency in accessing information through the internet
Your preview ends here
Eager to read complete document? Join bartleby learn and gain access to the full version
- Access to all documents
- Unlimited textbook solutions
- 24/7 expert homework help
i.
Knowledge of billing and collection techniques
j.
Claims completion
2.13 Activity: Matching: Skills
2.14 Personal Image and Behavior
1.
Projecting a professional image is important for any health care professional
2.
Appearance and perception play a key role in patient service
3.
The following are general rules to project a professional image:
a.
Be attentive to apparel and grooming
b.
Review and follow the health care organization’s dress code policy
c.
Present yourself in an appropriate and professional manner
d.
Portray an image of confidence and security to the patient
e.
Treat patients and co-workers with courtesy and respect
f.
Communicate effectively
4.
Professional image is more than just apparel and grooming:
a.
From words and actions;
i.
Employers
ii.
Colleagues
iii.
Patients
iv.
Will form a mental image of the kind of person you are
b.
This image whether accurate or not:
i.
Is based on the sum of many impressions – often first impressions
ii.
That can be distorted by a relatively small number of negative ones
c.
Be kind, honest and a team player
i.
Be dependable and on time
2.15 Lesson 2 Conclusion
Lesson 3: Medical Etiquette, Ethics and Liability
3.1 Lesson 3 Introduction
1.
Etiquette:
a.
The code that governs the expectations of social behavior
b.
Medical etiquette:
i.
The code of conduct that governs the expectations of behavior in the field of medicine
2.
Ethics:
a.
Based on moral duty and obligation
b.
Similar to etiquette, that it governs conduct and behavior
c.
Medical ethics:
i.
Evaluates these activities in medicine:
1.
Merits
2.
Risks
3.
Social concerns
3.2 Objectives and Reading Assignment
3.3 Medical Etiquette
1.
The focus for the Insurance Billing Specialist is good customer service
like any other business
a.
Who is the customer?
i.
It is the patient
b.
They should have a basic knowledge of what is proper conduct in the workplace
2.
The Billing Specialist has many other customers:
a.
Providers
b.
Outside personnel
c.
Vendors
d.
Other health care professionals
e.
Co-workers
f.
Your employer
3.
Your conduct can be summed up in 3 words:
a.
Consideration for others
b.
The Insurance Billing Specialist should always:
i.
Be courteous
ii.
Maintain a professional demeanor
c.
Always:
i.
Acknowledge others with a smile or greeting
ii.
Apologize for mistakes
iii.
Be attentive
iv.
Be friendly
3.4 Email Etiquette
1.
In business, much of your communication takes the form of electronic mail (e-mail)
a.
This medium allows people to send and receive messages quickly
i.
It is important to maintain formal standards
ii.
The messages you send are a reflection of your professional image
iii.
An example of a professional email and its elements:
2.
Here are some tips for composing a professional message:
a.
Clearly identify yourself and the reason for your message
b.
Be clear and concise (short)
c.
Use proper grammar and correct spelling
d.
Do not write in ALL CAPS
e.
Do not use text elements like colors or different fonts
f.
Avoid use of “text speak” to shorten words and use abbreviations
i.
Text speak:
1.
The process of shortening words and using abbreviations that do not follow standard grammar, spelling, and punctuation
2.
Ex: “TY” for “thank you”
g.
Avoid use of “emoticons” to convey emotion, gestures, or expressions
i.
Emoticons
1.
A short sequence of keyboard letters and symbols used to convey emotion, gestures, or expressions
2.
Ex: a “smiley” 3.
Regular email must not contain the patient’s health information
a.
The health facility will have a secure and encrypted email service for confidential information
3.5 Activity: Labeling: Email Etiquette
3.6 Professional Ethics
1.
Ethics are a moral guide for behavior
a.
You may encounter situations in which your actions (or inactions) may:
i.
Not break the law, BUT would be an ethical violation
1.
Ex: Many patient visits for seemingly simple procedures are coded with a higher level history and physical examination (H&P) than would be expected
a.
The coders tell you that when a patient has a certain type of health insurance, they are instructed to code with a detailed H&P – Which results in higher reimbursement for the practice
b.
You know this is wrong and decide to quit, but should you report the provider to the authorities?
c.
On the one hand, everyone at the clinic will likely lose their jobs
d.
On the other, the provider is essentially stealing from the insurance company
2.
May not be illegal for you to remain quiet BUT it is unethical
a.
Acting with ethical behavior:
i.
Carry out one’s responsibilities with:
1.
Integrity
2.
Honesty
3.
Competence
4.
Respect
5.
Fairness
6.
Trust
7.
Courage
2.
The American Medical Association (AMA)
adopted a modern code of ethics in 1980:
a.
The Principles of Medical Ethics
i.
Serves as a guide for physicians’ standards of conduct for honorable behavior in the practice of medicine
3.
Most professional organizations for Insurance Billing Specialists or Coders have established their own code of ethics for their members to follow
a.
The content of the ethical codes are decided upon by the members of the organization
4.
Standards of Ethical Coding from the American Health Information Management Association (AHIMA)
a.
https://bok.ahima.org/CodingStandards#.YFwzxkBuLIU
3.7 Scope of Practice and Liability
1.
The clinical health professions are governed by state practice acts that dictate the things a professional’s license allows them to do
2.
The scope of practice
Your preview ends here
Eager to read complete document? Join bartleby learn and gain access to the full version
- Access to all documents
- Unlimited textbook solutions
- 24/7 expert homework help
a.
Draws a boundary on things that clinical professionals can do
i.
Things that they are not supposed to do
3.
The field of medical billing and coding does not have such a well-defined scope of practice
a.
Instead, professionals in this field are guided by:
i.
Job descriptions
ii.
Codes of ethics
iii.
Coding policies
iv.
Internal compliance policies
v.
Insurance carrier policies
vi.
Health care regulations
b.
Regardless of whether they are involved in:
i.
Facility billing
ii.
Professional billing
1.
Coders must be aware of their own liability
3.8 Employer Liability
1.
Vicarious Liability:
a.
A rule that all activities performed within duties and responsibilities defined in an employee’s job description falls under this rule
b.
Means that employees (including health care providers) are:
i.
LEGALLY responsible for the actions and conduct of employees when performed
within the context of their employment
2.
Known by its Latin term:
a.
Respondeat superior
i.
“Let the master answer”
3.9 Employee Liability
1.
The doctrine of respondeat superior does not mean that an employee cannot be:
a.
A party to a lawsuit
b.
Brought to trial
2.
If an employee knowingly submits fraudulent claims to Medicare or Medicaid:
a.
Both the employee AND the employer can be tried for breaking the law
3.
Medical Biller/Coders, including Medical Insurance Specialists:
a.
Can be held accountable under the law for billing errors
4.
There are numerous cases in which ancillary members of the health care team have been listed as defendants in billing fraud lawsuits:
a.
If a Medical insurance specialist or Medical Biller/Coder knowingly submits a false claim OR allows such a claim to be submitted
i.
They can be liable for a civil violation
b.
Concealing or failure to disclose information to obtain payment is illegal
i.
All parties involved can be held legally responsible
5.
The Insurance Billing Specialist should check to ensure they are covered under the employer’s professional liability insurance
a.
AKA malpractice insurance
i.
This offers financial protection from lawsuits
3.10 Independent Contractor Liability
1.
Any company / organization / individual that provides professional services to others for a fee or
other consideration has exposure to litigation
2.
An Insurance Specialist operating as an independent contractor a.
Would NEVER
be covered under the malpractice insurance of the health care organization that they contract with
3.
Errors and Ommissions (E&O) Insurance
a.
Protection against loss of money caused by failure through error or unintentional oversight on the part of the individual or service submitting insurance claims
3.11 Claims Assistance Professional Liability
1.
Claims Assistance Professional (CAP)
a.
Assists individuals and families in managing medical claims
b.
This assistance can include:
i.
Documenting, submitting, and monitoring the progress of an insurance claim to a third party payer
ii.
Negotiating with providers
iii.
Educating patients about insurance benefits and options
2.
A CAP may not interpret insurance policies or act as an attorney
a.
When a claim cannot be resolved after a denied claim has been appealed to the insurance company, the CAP must:
i.
Be careful in rendering an opinion OR
ii.
Advising clients
1.
That they have a right to pursue legal action
2.
Always check in your state to see whether there is a scope of practice
3.12 Activity: Choices: Scope of Practice and Liability
3.13 Future Challenges
1.
A major percentage of a medical practice’s income is received in the form of third-party reimbursements
2.
The Insurance Billing Specialist’s responsibilities lie with:
a.
Maximizing these reimbursements through:
i.
The generation and submission of insurance claims
ii.
While staying compliant with laws and payer guidelines
3.
Providing physicians with exceptional expertise in:
a.
Billing
b.
Collections
c.
Ancillary services
i.
That maximize their income
4.
You become invaluable by offering them quantifiable results so that they can stay focused on patient care
5.
Ignorance of the law and payer guidelines is not a protection for anyone working in a health care
organization
a.
“Knowing your stuff” is part of the job
i.
Learning doesn’t end when school is over
ii.
The successful Insurance Billing Specialist must stay well-informed on:
1.
State AND Federal statutes
2.
ALL payer guidelines
6.
Keep current by reading the latest:
a.
Health care industry association publications
b.
Participating in listsery discussions
c.
Joining a professional organization for networking
d.
Attending seminars on billing and coding
3.14 Lesson 3 Conclusion
Module 1 Conclusion