| EDUCATION RESOURCES
Success as a medical biller requires
gaining a new body of information for most people. Your background will give you varying
degrees of preparation for the many parts of the business.
An understanding of computer operation is
necessary. Familiarity with the basic commands of software manipulation should be learned.
A variety of publications and educational resources are available to accomplish this.
The software consists of two components, a
relational database management program and an electronic communication program. The
database consists of a series of files, each containing discrete information about the
providers' practice (a listing of procedures, diagnoses, institutions, patients, etc.).
The relationship of this information is brought together when a claim is created in the
transaction file. A number of claims are assembled as a batch in a single format,
regardless of the end disposition. The communications component transmits this batch via a
phone line to the receiver during electronic transmission, or the database component
prints it out to a claim form (HCFA-1500) or a patient statement.
An electronic batch usually goes to a
clearinghouse for editing and formatting. The batch is disassembled and redistributed to
the proper receiver (an insurance carrier or governmental agency). If the carrier does not
accept electronic claims, the clearinghouse will "drop" the claim to paper and
mail it. The clearinghouse is paid a variety of fees for these services; setup,
maintenance, support, and transmission.
Information is received from the providers'
offices already coded. Coding is the translation of physical procedures and diagnostic
conclusions into numerical format. The basic manuals for this task are the ICD-9
(International Classification of Diseases, 9th Edition) and the CPT (Current Procedural
Terminology). When billing occurs on-site, the biller is usually asked to provide coding
selections. This is impossible when the biller is off-site. The provider may be unaware of
this distinction. It must be understood that billing is a bookkeeping task, not a medical
task. There is no practical need for the homebased biller to understand medical
terminology or coding techniques. Education for these subjects is purely discretionary.
Sending just bills is known as a
"claims only" task and is often applied to Medicaid billing, where no followup
is necessary following payment by this agency. "Full practice management" occurs
when payments are posted against outstanding bills and rebilling is done. The biller may
also note the aging of balances and notify a collection service or third-partly letter
company to pursue the collection of delinquent accounts.
The entry of data in the software program
is the business element that captures the most attention from those investigating this
business. It is assumed that this is the most critical element of business development.
This is usually the result of the technical tendency of the entrepreneur and promotional
tactics by software salespeople. The basics of this data entry ability can be learned in a
variety of ways. Different companies will offer 1-2 day live classes in data entry, books
are available, operational manuals are included with all software packages, sets of
videotapes are available, private coaches can be hired. The average individual at a cost
of less than a few hundred extra dollars can accomplish complete understanding. There is
no need to spend thousands of dollars and weeks of instructional classtime for this type
of training.
Finding clients is a greater challenge. The
average provider earns $200,000+ yearly, which is the result of an existing in place
cashflow system. The doctor will not want to risk this cashflow by replacing it with the
untested skills of an inexperienced entrepreneur who can offer no evidence of his/her
capability or reliability. The new biller must ignore all attempts at attempting to win
over a cash-satisfied provider and, instead, focus on finding a physician in distress.
Despite the claims of marketing experts, you can develop no marketing letter or brochure
that will be successful. No doctor "friend of the family" will accept your
service. Your only path is to find a need and fill it. This will require an extensive
campaign to find such providers within a large population of prospects. The larger the
population, the more likely you are to succeed. Typically, you must market to a population
of 1,000 providers to find 2-3 providers who need your services. If you have a sufficient
"farm" of prospects and apply a persistent drive of promotion, you should
develop your first client(s) after three to six months.
Books on setting up your business and
marketing your new business are available through the Network. A complete training course
is available through homestudy, resulting in the designation Certified Electronic Medical Biller (CEMB).
Brochures linking you to the national association are available, as well as software,
clearinghouse and trade manual discounts. Supplies, marketing materials, and professional
services can be found through the association, even clothing bearing our distinctive logo.
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