Medical Billing FAQs

Answers:

Q: What does medical billing entail?

A: Medical billing encompasses the billing of patient encounters (visits) and accounts receivable management functions for health care providers, both in the doctor's office and the hospital. A new field is “health insurance specialist,” which is a level of billing that deals with understanding the rules and reimbursement criteria of all third party payers. With Billing and Health Insurance Specialist knowledge, you will find employment in various provider settings.

Q: Is billing viable home-based business?

A: Yes. There are a remarkable number of home-based billing operators working from home. But somewhat contrary to what you may have heard or read, it’s not a quick and easy undertaking to set up and get started. Too often medical billing is confused with electronic claims submission, which is in fact another type of service that may be home-based. The next question and answer addresses the differences.

Thorough training in medical terminology, coding, billing, billing operations, and collections, is required before approaching a provider to convince her/him. It helps to be able to "talk the talk," understand the law; know how to recover revenue from payers, and provide good reports for analysis. Our program teaches all that is necessary to become employed or to set up and run a successful medical billing operation.

Caveat: Don’t be fooled by the promises made by the medical billing or electronic claims software vendors who say you will make $50,000 a year in the "hottest opportunity of the new millennium." If you want to get into medical billing, get trained first, understand fully what you can sell, then make your decision. The government agencies who monitor scams list the medical claims processing, e-claims, etc., as the highest profile for scams.

Q: What is the difference between electronic claims submission and billing?

A: Medical billing refers to billing and accounts receivable management, whereas electronics claims submissions refers only to a small element of that process, submitting electronic claims in a readable format to a payer rather than mailing a paper claim (insurance form). Electronic claims are telecommunicated to either insurance companies or to electronic claims clearinghouses that “clean the claims," and submit them to the payers (e.g., insurance companies, etc.).

There are many companies offering turnkey electronic claims submission home-business programs for investments of anywhere between $250 and $8000. But you have to do your homework. The Federal Trade Commission has published a great deal of information on the prevalent scams.

Q: I’ve read that these turnkey home-based electronic claims submission and/or billing operation packages are enough to get me started. Are you saying that they aren't?

A: Yes, that’s what we’re saying. Purchasing a software program and trying to market just that element of service is pretty daunting. You still have to have the basic training on how all of the process works and what’s involved to be able to assume the responsibility of providing the service. It is definitely a knowledge-based process. Software is simply a tool you use to accomplish your billing, coding and accounts receivable functions.

Q: How do I get paid in medical billing?

A: That depends on your objective. If you decide to go to work for the business office of a care provision facility, you’ll likely be salaried (and this isn’t a bad way at all to get more experience). Entry level pay* is generally $35K to 50K per year, with incentives, fringe benefits, bonuses, etc.



If you decide to set up a billing operation, you typically charge a percentage of the collected revenue. This is all well covered in the course materials, the HomeBiz-Med Book.

If you decide to get into electronic claims submission, you charge by the claim. Remember that you must also pay the clearinghouse a fee to process that same claim.

Q: Do I need to be certified?

A: More and more government (HCFA) requirements are oriented toward having all billers certified (and requiring continuing education credits). The course will prepare well for any certification exam (there are several available). We recommend www.med-certification.com for the CBS (Certified Billing Specialist) practice testing and examination process.

Q: Is medical billing really going to be one of the "hottest home business opportunities" of the coming years?

A: Traditionally, medical billing is a good home business. All of the recent hype about medical billing has been more about electronic claims submissions from home, (not medical billing), as has been discussed above.

Q: Is electronic claims submissions a legitimate home business opportunity?

A: It can be, yes. The problems are these: A good many care providers use billing companies to handle their billing, and most of those billing companies already do electronic claims submissions. The rest have a billing office in their facility, and a good many of them already submit claims electronically. If a company selling a package is simply giving a list of providers to contact, then the buyer is the one doing the marketing, and that process can be a tough market in terms of competition.

Q: Is Meditec's training sufficent for me to enter these fields successfully?

A: The course will train you to do the work, but ultimately, the successful implementation of your new skill is up to you. The training, books, and notes you make will become your constant and long-time companions for reference work. You will surprise yourself at the depth and extent of your new knowledge. All of our programs are based on platform-learning systems which teach in a way designed to maximize the retention process. Ideas for your new career are abundant for your review in the HomeBiz-Med Book. Also included is the new specialty termed, "Health Insurance Specialist." That addition really rounds out your marketable skills. More medical providers now hire “Health Insurance Specialists,” which is well covered in the training, and a specialty of medical billing.

If you are seriously considering medical billing, please read about coding too since that is so closely aligned with the billing process. Meditec has a combination course that includes the coding.