how does billing/coding work for insurance & medicare?
November 24th, 2009 by admin
I am trying to start a business & want to know every aspect of it so I won’t get ripped off in anyway. Don’t want to go to school to learn it, just want a few details on it.
not looking to do it myself, I am the owner, just want to know a little about it so when I hire someone to do it I will know something about it. Looking for basic info so I can ask the person certain questions so I can tell if they really know what they are doing.
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you HAVE to go to school to learn that. there are tons of billing and coding to learn for insurance. allot more than what you can learn on your own. no one will want you to do their work for their practice if you are not qualified.
Any person you hire for your business must be certified either as a physician (outpatient) or a hospital (inpatient) coder. There are special designations you receive when you get certified as a coder, such as CPC, which means certified physician coder, CPC-H, hospital coder, CPC-P, CCS, CCS-P, RHIT or MD etc. There are 2 professional organizations that test you and give you your designation. one is the American Academy of Professional Coders, short for AAPC. They have a website http://www.aapc.com where you can look up someone’s credentials before you hire them.
As far as experience or training: Make sure their knowledge is up to speed. Ask for credentials, type of education they have accomplished and what their future goals are. A good billing person should be knowledgeable about coding issues and be able to spot errors and advise on corrective action. Is your billing company HIPAA ready? You will need to create a HIPAA compliant policy and environment for your company.
Request references. If references are not available, ask them if they can give you some references from Association Directors, teachers, course instructors, etc. This will give you a good idea of their work ethic.
You will also need a compliance plan. A committed billing service will have a full compliance plan in place. This is the road map and guide for your business and any prospective clients you seek will want to look at this to determine the commitment of your billing company before they hire you to do their coding. Ask questions such as “How will you follow up on claims?”. What type of appeal system do you have in place? Ask what type of reports they can provide for your clients. How frequently (monthly, quarterly, annually) Reports should consist of the following BASIC reports: Accounts Receivable – aged by either date of entry or date of service. Practice Analysis – overall reporting of the practice charges and receivables. Transaction Report – general report of payments, charges and adjustments. Claims Report – to show claims submitted for a reporting period. Managed Care – reports to show loss of revenue, adjustments, timely payment and referral tracking. Are they up to date on their coding books? I know this is more than a little information; however don’t be misled that this is an easy business to start. Competition is very strong in this field and the people you hire will need to know their stuff because an experienced coder can demand wages of up to 30.00 an hour depending on the area. I hope this information helps you and best wishes to you in your endeavors. I am confident you can succeed with the right people behind you.
dont mess around with this, if the people you hire mess up you are as liable as they are. Insurance fraud is jail time and ignorance is not an excuse.