A community of 30,000 US Transcriptionist serving Medical Transcription Industry

Research for a school project - current billers help please! - future biller

Posted: Jan 21, 2014

I am current in school as a medical insurance specialist and we have a group project that we are struggling in. We have to research what a medical biller/coder does in an office of approximately 3-4 physicians, if they even do their own billing. These days, many smaller doctor's offices just send out their billing so it is kind of hard to find. If you do billing/coding in an office, could you help? What are your general duties? Do you also do front desk work or other duties that are kind of outside to scope of billing? How many insurance companies do you work with approximately? Any kind of information would be appreciated. I have sifted through pages of things to find such answers and the majority of things I find are education programs trying to get you to join. Thanks in advance.

What did your school tell you? - Coder, not biller

[ In Reply To ..]
We have never seen a biller around these here parts, but most of us know some. We can probably help if you get us started.

What did your school tell you it was? All the medical office billing books I have seen were on target, What did yours say?

I can tell you that "biller-coders" are billers. The fact that they enter codes on bills does not make them coders. Billers can type codes and even look up a few without being considered coders. It is a clerical or business occupation. Billers are responsible for the accuracy of the bill and the billing operations, but the physician in an office and the coder in a large facility are responsible for the accuracy of the coding. Our billers, for instance, may not read a record for coding purposes, decide on a code or change a code. It isn't their job.

Coders are certified by AHIMA and the AAPC, and may hold a 4-year university degree and an RHIA. They are considered ancillary medical professionals like nurses, pharmacists, and physical therapists. They read medical documentation that may involve months or years of care, identify the correct diagnoses and8 sequences, determine the codes to the highest degree of specificity, and juggle coding guidelines, third party payer, Medicaid and Medicare rules, and other factors to produce a set of codes that accurately describe services and optimize payment ethically and legally. This function is not just for payment, but for national disease and procedure statistics, research, and facility workload accounting in terms of things like DRGs and case mix. They also use their understanding of medicine to anticipate what should have occurred, to identify indicators of missing documentation, and work with the physician to complete it in order to optimize case reporting.

A copy of their work, or part of it, goes to the billers, who generate the bill, deal with the insurer, handle denials, receive payment, bill the patient, get the patient to pay their part, etc.

In an office, much of that heavy-duty coding work is not necessary. Billing in small, uncomplicated specialties does not require an actual coder. The doctor does the coding, the biller bills, and they may only bring in a coder to perform audits once or twice a year, develop the chargemaster, advise on documentation, etc. The more complicated the specialty, the more a professional coder is needed to ensure that the office desn't go broke or go to jail. Surgeons and radiation oncologists often need them, for instance. They also need them to advise on complete documentation to satisfy insurers. Usually, an office that has a professional coder also has a biller, because it is too expensive to pay the coder to do noncoding work.

So, I think office billers generate bills, deal with patient insurance issues (eligibility, etc), appeal denials, collect documentation to accompany some bills, take payments, phone patients about all of this, and probably suffer a great deal of stress over what has to be a thankless job.

Did that help? And, do tell us what an insurance specialist is ... sounds interesting.

I don't know if I can help - anon

[ In Reply To ..]
I work in a hospital doing billing and charging for offices that the hospital provides billing for. I don't code -- I enter charges from the offices on a sheet and then verify insurance information. I stay very busy ... from what I was told, we work with about 400 different insurances. But that's a hospital perspective, not an office perspective. Sorry I can't be more helpful.

And again, student asks question requiring major effort - and never returns

[ In Reply To ..]
SM

Ah- Wrong I did return so take that - whysonegative

[ In Reply To ..]
Wow, sorry I did not meet your time frame. I work 2 jobs and go to school so I dont have a lot of time until a weekend. Sorry I asked a question from such a negative nelly.

You still did not thank the people who - tried to help

[ In Reply To ..]
NM

Similar Messages:

Jan 06, 2015

why coding would not eventually be replaced by electronic systems in the future? Do they not have software that can pick out words from the text and assign the codes? What does a coder do that cannot be automated by a machine? Please don't think I am being insulting. I know very little about coding and have just started researching it. I am an MT for 20+ years. ...

May 24, 2013

Any companies that use medical billers at home? ...

Jun 02, 2013

I have medical accounts receivable and payable, does anyone work at home doing billing and WHO do you work for. Thanks :) ...

Oct 28, 2010

Are there any billers/coders out there who specialize in pain magement, ie, facet injections/aspiration and lavage, etc, for outpatient pain management physicians? I have questions about documentation needed for injections and such with the 'add on codes', for example with the injections, there are codes for the first level then additional codes for second and subsequent levels. Is it necessary for every single charge to have a report on it? It's causing severe headaches for the ...

Nov 19, 2010

Hi. I am an MT turned IT consultant implementing EMR/billing software for a doctor's office. Regarding electronic clearinghouse services, are they worth it? I know that Medicare, Medicaid, and BCBS have their own interfaces at no cost, so I am wondering if it is worth the setup time to go that route or if a clearinghouse makes things so easy that it is worth the monthly fees. If you prefer the clearinghouse, why, and which service(s) have you used? Thanks in advanc ...

Jul 27, 2012

If you're on the project, you know the company. What are your thoughts? I'm ready to tear my hair out. Glad to be employed, but think pay should be more for this. ...

Feb 28, 2013

nm ...

Jan 25, 2011

For those who took the test for All Type's six month project, have you heard anything back yet? ...

Sep 11, 2012

So what about this mandatory project for company to look at our computer specs and compatibilities? Is this a way to "spy" on us? What if the virus protection says the download is not safe? (not talking about the certificate, but the download.) Do we risk screwing up our machine (at our expense) to do what they say to do? ...

Jun 01, 2014

Groupon is offering this course right now for $99 - regularly $1495??? but I don't really know what a project manager is. Can anyone explain? ...

May 22, 2015

If so, how is your line count and quality? ...

Aug 05, 2010

Trying to find out what the going rate or at least an idea of what to charge for a non-medical transcription project..Would appreciate any feedback including whether it is still charged by the line or page and what a reasonable rate would be. Thanks! ...

Oct 10, 2014

Hello Medical Transcriptionists, Past and Present! I'm doing a survey of current and former MTs for my Intro to Statistics project. Your participation would be deeply appreciated! Answers are confidential. I’m collecting data about MTs in the USA - what they know, what they have experienced, and what they think. Data will be compiled, analyzed and presented in a final report. Please consider adding your voice to this project. Your input ...

Dec 21, 2011

:) ...

Nov 16, 2010

Wondering if shift differential is a common thing for radiology MTs. Any rad MTs out there get it? If so, what hour of the evening/night does it kick in? ...

Jul 29, 2011

Which search engine do you find most effective for finding words? Please share your favorites!! ...

Nov 11, 2012

WOW. I wish I had done my homework before accepting even a PT position with this company. To date, paperwork in, but nothing for a few days now. After accepting this PT position I happened upon this forum and have already started looking for a new job. I am supposed to start with Nuance in a week working 7-11 pm CST. Not ideal hours but I guess what they had available. Been in the business for almost 15 years and have never heard so much negative about one pla ...

Jun 24, 2014

I was wondering if anyone has ever gone through Allied School in California for billing & coding. If so, how was your experience? Were you able to find work in coding after finishing the course and getting your certification? I have been a medical transcriptionist for the past 10-11 years and am now looking at getting into coding. My best friend and I are going to take a course together. If you wouldn't recommend Allied as a school, who would you reco ...

Dec 01, 2010

I am looking for a resource where I could plug in the symptoms and perhaps come up with a diagnosis or name of a condition. There must be a site like this by now--a Dr. Google, if you will. Does anybody know of such a thing? ...

Oct 10, 2011

We've always known it, but now the medical research is bearing out the same truth: MTs are more accurate than speech recognition. I try to keep track of studies like this; they're good ammunition! http://www.ncbi.nlm.nih.gov/pubmed/21940580 ...

Jun 27, 2013

The acct I am on, we have "free text cc's." you have to go into a seperate website, search the doc data base for the name and then type that info on the report. You know how long that takes? This acct I am on has 20 pages of rules.. I did not ask to be put on this acct, I was switched over and now am on 100% QA as I entered a DOS incorrectly. Can you say fed up with this for minimum wage?? It is just too much. Retirement is looking thank the Lord. ...

Oct 15, 2013

Hey everyone, I'm doing some market research on transcription and was wondering if you might be able to give me some pointers? Firstly I'm trying to figure out who the biggest players are and I've come up with Nuance and M*Modal. These seem to be by far the biggest, but I've also found some smaller companies like Presyce, Superior Global Solutions, TransTech, Acusis and MedScribe - are there any others I'm missing? I'm also looking at the pricing these companies ...

Feb 12, 2014

That can't be posted or emphasized enough. Whatever job posting seems good, research it and double check everything before sending a resume with all your personal information. Do NOT EVER accept any checks (especially written for large sums) from any companies to purchase anything - that should be nothing but common sense. People, you're broke now, and desperate for a job, but how much more broke are you going to be if you fall for these types of iden ...

Mar 24, 2015

What are your favorite research tips? Any suggestions on how you cut down research time and increase productivity? I need to get my productivity up, seriously! Would appreciate any suggestions to that end, thanks! ...

Mar 16, 2010

For all that do not want to do the extra research to fill in the blanks cuz it takes too much time, too much effort, losing money trying to get it all done to help your qa submission rate I'd like to welcome you to what we as QA/MME have been doing for 3 cpl ....all of that research and more. Now maybe some MTs (not all) will stop throwing QA under the bus and realize what we've had to do all this time for 3 cpl. Thank you and have a nice day. ...

Jul 13, 2013

Hi Everyone, I was wondering if any of you have ever heard of a company called Pick Research Solutions. It looks like they are paying 1 dollar per audio minute, and I have never done audio minutes before. It looks like the job I would be doing is transcribing one-on-one telephone interviews at about 45 minutes in length. I really don't know how long it would take me to do it, but I do know that I type 80+ words per minute, but more importantly, the question is if anyone h ...

Sep 06, 2013

about $3.00 an hour!! That's working for Nuance. ...

Mar 02, 2015

Would anyone be willing to give me a quick interview? Questions include: How did you get into field? Why did this field appeal to you? Does it meet with your satisfaction? Years of employment and level of responsibility? ...

Apr 27, 2012

Hi all. I'm wondering what sites are your favorite for drug researching? The main issue right now is a sentence that has me wondering. It says: "The patient has no known allergy for the s/l listed." I've never heard it put that way before. He must be talking about the meds the patient usually takes, but, if he's been taking them, of course he has no allergies to them! This is a separate sentence as I have it in caps. Do you need anything else? I have tried looking up anything tha ...

Dec 11, 2012

So I guess that was just legal boilerplate for CYA, since there were no pay changes for EditScript. Like what we're paid per line automatically includes enough "extra" to cover for these duties, supposedly. "Base Pay Program Philosophy .... Compensates for all time spent typing and editing reports; to include researching, proofing, and demographics" (I always screenshot these conferences/presentations, since we never get any written/e-mail followup that includes all the ...