Medical coding and billing may be inherently noble professions but they’re no strangers to scams and frauds. In recent years, countless fraudulent firms have tarnished the reputation of these professions, leading to a range of misconceptions among the public.

As such, we consider it our moral responsibility to spread awareness about these scams so as to ensure our readers remain safe. If you operate a healthcare center and are about to bring a medical coder or biller on board, read this guide to steer clear of frauds and scams.

Scam #1 – Upcoding:

By far the most common scam plaguing the healthcare sector is upcoding. To understand what this is let’s consider the example of a patient who visits the local hospital to receive treatment for a sprained wrist.

Once the treatment is completed and the bill is generated, the insurance provider sees that the patient was billed for a broken wrist. Obviously, broken wrists cost more to treat than sprained wrists, but the healthcare provider gets to make more money in the process—fraudulently of course.

It goes without saying that any mismatch between the services offered and the services billed for is a federal offense and can leave your firm facing substantial lawsuits. To give you a ball park figure, the University of Texas Southwestern Medical Center had to pay a compensation of $1.4 million in an upcoding lawsuit back in 2011.

Scam #2 – Unbundling:

Most insurance providers try to save money by offering bundles (i.e. payment plans) for complementary medical services. For example, if you have a minor surgery coming up, then there’s a high chance that local anesthesia will be administered. As a result, the insurance company offers surgery bundles that cover the price of the anesthetic.

Now, a healthcare center could try to bill these services (the surgery and the anesthesia) separately which violates an existing bundle. This (theoretically) entitles clinics to higher reimbursements from insurance providers even though it’s a scam through and through. This deplorable act is called unbundling.

Scam #3 – Phantom Billing:

While upcoding can be written off as a typographical error or a genuine mistake, phantom billing is much more sinister in nature. This scam occurs when healthcare centers charge for medical services that they never performed to ensure that they receive higher reimbursements from their insurance providers.

That being said, it’s worth noting that not all firms that have been caught phantom billing did so out of malicious intent. In fact, there have been countless cases when healthcare center employees have mistakenly copied information from other patients (who actually opted for the services mentioned).

Whether done deliberately or mistakenly, phantom billing is serious a federal crime which can be avoided by opting for the services of a certified medical coder! The Allied Prep Technical Institute offers comprehensive medical billing and coding courses to our students so that they’re better equipped to avoid scams and offer ethical services.

We run a medical training institute that offers students and coding enthusiasts the medical billing and coding certifications – both on campus and online. Our rigorous tests and training programs ensure that our students always have the knowledge and the expertise needed to deal with complicated problems.

Contact us today to learn more about how you stand to benefit from signing up for our classes!

Dear Google,

I am preparing for a career in medical billing. I want to know how medical billers spend an average day at work.  What do they do? Who do they interact with? How much workload do they have? Do they have flexible work timings? And any other additional information that you can provide me with to help me better understand of what I can expect when I get into the workforce.

Google is reading your message and writing a reply…

Hello, Aspiring Medical Biller!

An average day in the life of a medical biller is quite exhaustive. You have plenty of claims to create. You have a lot more claims to file. And then, there are some returned rejected claims that you have to review, correct and file again, so that the patient and the doctor can be properly reimbursed.

This can be all too tiring.

But come the end of the day, knowing that you made a difference in the life of yet another patient is definitely satisfying. You get a sense of accomplishment that only medical billers can relate with.

Your job is one of the most satisfying jobs out there and it also pays quite well.

When you will join your first organization, probably the very first question that your employerwill ask youis: what shift timings will you prefer?

A medical billing job offers flexible shift timings. You can choose any schedule you want. Some medical billers are early birds; some love working in the afternoon, while others are happy to work at night.

During their shift, a medical biller is expected to complete and file a fixed number of insurance claims. This number varies from employer to employer. Before leaving for home, you should complete and file the claims assigned to you for the day. Of course, some claims take time to be created, so unless there is a pending deadline, you can take your time.

Medical billers must make sure that the claims they are creating are accurate and free of all errors. For that, a medical biller needs to be in constant communication with doctors, medical coders and the respective insurance companies.

Besides creating, filing and reviewing disputed claims, medical billers may also have other job responsibilities.

Some medical billers deal in full practice management where they handle all aspects of billing for the organization they are working. That is, from submitting claims to tracking accounts payable and receivable to billing patients.

These other responsibilities do not require the understanding of medical coding schemes, but are nevertheless detail intensive.

So, the Aspiring Medical Biller, does this answer all your questions?

Do you have some more questions to ask?

Google recommends consulting the expert team of Allied Prep Technical Institute for any further help.

For now, Google would like to take your leave.

Good luck for your future!

A BONUS read: 9 Qualities that Put You at the Top of the List for Employers After Medical Billing Certification.

 

There are countless medical brochures that promise a life of riches to medical billing students provided they sign up for a six weeks course. Promotional brochures take sensationalism to the next level by falsely promising lucrative incentives like short work hours, easy workload, and simple training, etc.

It goes without saying that these statements are senseless myths that don’t have a shred of truth attached to them. As such, we’ve decided to discuss and debunk a few of the most commonly heard myths about the noble profession of medical billing.

Myth #1 – Medical Coding And Billing Are The Same Profession:

The biggest misconception people have about medical billing is that it’s the same thing as medical coding. Given the fact that the aforementioned promotional brochures use the two terms interchangeably, it’s no surprise that this is one myth that just refuses to go away.

Make no mistake about it; medical coding and medical billing are two different (but complementary) professions. The former is about transforming medical records (such as prescriptions and test results, etc.) into alphanumeric codes so that they can be understood by the medical biller.

Similarly, a medical biller takes these alphanumeric codes and generates an easy-to-understand bill. However, prior to medical bill generation, the medical biller must also verify the validity of medical and insurance documents so that the patient is guaranteed a quicker and a smoother healthcare experience.

Myth #2 – Medical Billing Professionals Work From Home:

Although mobility may be the talk of the town in the healthcare industry, medical billing – as a job – isn’t necessarily performed from home.

Medical billing professionals, especially those who have less than 5 years of experience in their relative field, must work under the direct supervision of an industry veteran. This is done to ensure that a novice medical biller doesn’t make any errors in the process which may lead to processing delays.

However, once a billing expert has worked in their industry long enough, medical and dental practices are more than willing to let them work from home.

Myth #3 – Medical Billing Is Easy:

By far the worst thing we’ve heard about medical billing is that it’s easy. The general public (and even doctors to some extent) constantly undermine the importance of medical billing and the work done by medical billers by calling their work unimportant and simple.

Contrary to popular belief, medical billing is NOT an easy profession. First and foremost, the medical biller needs to acquaint themselves with standard medical code sets and subsets. Extensive knowledge about these domains makes it easier for the biller to convert codes into healthcare claims that must be submitted to the insurance company.

Once the claim has been processed by the insurance company, the returned claim is handed over to the medical biller for final verification. The medical biller must then draft a final bill that takes every detail into account and is in line with the claims of the insurance provider.

That being said, this doesn’t mean medical billing is rocket science as there are some simple steps you can take to improve your understanding of the noble profession. You could choose to enhance your understanding by enrolling in medical billing online classes offered by medical training institutes.

Allied Prep Technical Institute also offers comprehensive classes that will help you develop a better understanding of medical billing and give you a competitive edge over your peers. Enroll in our classes today to significantly increase your chances of succeeding in the billing industry!

Medical billing may have surged in popularity in recent years, but the profession has been around for decades.  Continue reading “4 Things about Medical Billing That You Need to Know”

In many ways, the job of a medical biller is unenviable. Continue reading “Common Medical Billing Mistakes to Avoid”

Your Medical Billing Certification Online course will help you familiarize yourself with the terminologies that you will find yourself using on the job every day. As a medical billing specialist, you must know what these words refer to or it might interfere with how well you can do your job.

Besides the billing terms that you will be bandying about, words from other fields will also be a part of your vernacular. For instance, the names of medical procedures, surgical procedures, diseases will also be known to you along with the terms in accounting. Moreover, you will also be expected to have extensive knowledge of the healthcare system and the field of insurance. Lastly, your employer will also expect you to know your way around medical code sets.

Nobody can remember everything. What you can do is take a course on medical billing terminologies that will introduce you to these terms and help you understand them. The better you are at recognizing what a certain term means, the faster you will be at your job. Otherwise, you will just be dragging along a dictionary with you all day long at work!
We have gathered here just some of the terms that you will be taught in the medical billing terminology course. Additionally, we have included their definitions for better understanding:

Allowed Amount

As you study Online, you will come across this term. It refers to the amount of money an insurance company will reimburse for a procedure/service. Whatever is left after the payment will be paid by the patient. However, the allowed amount is different from co-pay or deductibles and should not be confused with either.

AMA

The American Medical Association (AMA) is the biggest consortium of doctors in the US. They also publish a journal known as the American Medical Association. It is considered to be the most widely distributed medical journal globally.

Beneficiary

Another important term taught in the Medical Billing Certification, the beneficiary is the person getting the benefits based on the coverage they signed up under their healthcare plan. It doesn’t necessarily have to be the person paying for the insurance since some parents can also be paying for their young children – the latter being the beneficiaries.

Capitation

At your Medical Technical Institute, you will also learn about capitation, which is the arrangement between an insurance payer and a healthcare provider. Depending on the amount that is decided, the former will be paying a sum to the latter for every patient they treat. Health Maintenance Organizations (HMOs) are the healthcare institutions that usually have capitated arrangements. The objective is to get patients to sign up with an HMO who will reimburse part of the money that a procedure costs. The amount that is paid will be determined by several factors, such as the condition of the patient’s health, how old they are, any family history of all illness, their race, etc.

Civilian Health and Medical Program of Uniform Services (CHAMPUS)

Civilian Health and Medical Program of Uniform Services (CHAMPUS, now known as TRICARE) is also an important term to know for those interested in obtaining a Billing Coding Certification Online. CHAMPUS is the federal health insurance program that has been designed around service members – both active and retired –, their families, and the people who survive them.

Downcoding

Medical Billing and Coding Curriculum will also include the term, Downcoding. It refers to there not being enough evidence for an insurance company to approve of a claim for a certain medical service. A coder might say the medical service was performed but without evidence, the insurance company will remove those codes thereby also reducing the amount they would be paying to reimburse a patient.

Explanation of benefits (EOB)

Billing Coding Certification also involves knowing about Explanation of benefits (EOB). This document explains which services are covered by an insurance company. It is attached to a processed claim and can be used both by the provider and patient. Often EOBs are also used to indicate the reason behind a patient’s claim being denied.

Financial Responsibility

Where to Get Medical Billing and Coding becomes important when you realize how your certification influences your career choices in the future. For instance, financial responsibility is a term that you should be familiar with. It refers to the person or entity who owes healthcare provider money for the medical services the former was rendered. That means a patient and an insurance company can be both financially responsible.

Health Insurance Portability and Accountability Act (HIPAA)

Where Can I Learn Medical Billing and Coding is a question you should spend some time answering. Your course should help know about important terms, such as Health Insurance Portability and Accountability Act (HIPAA). HIPAA is a law that was passed in 1996 but still continues to affect the healthcare industry. It is divided into two titles, of which Title I has been designed to protect the health insurance of workers switching jobs. Title II, on the other hand, is centered on the standards and best practices that all facilities must adhere to, regarding electronic health care.

ICD-9 Codes

Knowing Where To Learn Medical Billing and Coding is important but so is knowing what the ICD-9 codes are. They are understood internationally and represent different medical condition diagnoses. They have been put in place after consultation from physicians and can be used to translate what the former says about a patient’s illness. The billing specialist will translate the diagnosis into ICD-9 codes, which are then added to a claim and processed.

ICD-10 Codes

The ICD-9 Codes were updated in 2014 and the updated version became known as the ICD-10. They work in the same way as their predecessor used to.

There are many Medical Billing and Coding Schools out there but if you want to be the best at your job, then you need to invest in the highest quality of Medical Billing Training available to you! Choose a course that covers all the essential terminologies that a billing specialist should know and you will have won half the battle!