As health care costs grow increasingly complex, providers are steadily more burdened with itemizing fees and directing collection to the appropriate party. From the solo practitioner to the 100-plus physician corporation, accurate and efficient billing is essential for timely compensation. Likewise, hospitals and emergency rooms that are operating on a 24/7 basis can not afford to cut corners when it comes to assessing and assigning the cost of each drug and service. While some establishments attend to these matters in-house, others outsource these tasks to medical billing services. Both options require competent and well-trained managers, possessing the skill sets necessary for medical billing careers.
A doctor’s office may field a professional staff capable of multi-tasking and great versatility. Given the nature of medical billing and coding, however, the presence of a dedicated medical billing manager is advisable. Insurance company policies and government regulations combine to make compliance a full-time job. New coding systems, such as the ICD-10-CM/PCS mandated by the US government for inpatient facilities by 2014, require many hours of training and practice. Furthermore, failure to comply with the new standards will result in severe fines and returned Medicare claims, for example. A medical office generalist will likely have neither the time nor the training for mastery of such a massive mandate. On the other hand, a medical billing manager is educated and experienced in adapting to new regimes when necessary.
Another factor in favor of utilizing medical billing managers is sheer volume. Estimates have physicians investing at least ½ hour per patient on paperwork related to billing. By necessity, this diversion cuts down on the number of patients seen or, at least, the amount of time spent with each patient. As a result, the quality of care may suffer. Similarly, a medical office manager is required not only to manage staff, but to oversee ordering and procurement, the patient schedule, operational accounting and the physicians’ correspondence. Accordingly, the efficiency of the practice is compromised when the office manager is inordinately consumed with medical billing issues. A staffer with a medical billing career provides needed relief to busy personnel.
Billing and coding is a field with an extensive vocabulary almost impossible to learn without daily immersion. Not only do medical billing career specialists need to be familiar with the anatomical and clinical terminology used regularly in a doctor’s office, but they must also be comfortable with the language of insurers relative to reimbursements and eligibility. In other words, a medical billing manager must be versed in both diagnostic coding and procedural coding. For instance, a coder may know the corresponding numerical representation for gastrointestinal reflux. Yet if this condition is part of a larger disorder, the medical billing manager must know whether to use a “comprehensive code” to match that illness or an additional “modifier” to indicate extenuating circumstances. Medical billing career training drills students in the recognition and proper use of coding verbiage.
In fact, education can make the difference when it comes to seeking employment as a medical billing manager. While insurance company standards, legal requirements, medical realities, software and terminology may continuously evolve, the billing professional – with thorough training – can be counted on to stay abreast of the changes. Moreover, the instruction they receive enables them to employ critical thinking skills when decisions are not necessarily cut and dried. Formal instruction also gives the medical billing career prospect an advantage when attaining certification in most states. Accredited training programs are familiar with examination requirements and tailor their curricula with such tests in mind. As the medical billing profession becomes increasingly indispensible in the healthcare industry, obtaining professional credentials will likewise become all the more necessary for a successful medical billing career.