Healthcare Coder/Biller Interview
What are your daily roles and responsibilities as a medical biller?
I perform many administrative duties daily. Some of the work I do include registering the patients and checking them in and out, prepare any claims received and transmitting them to the necessary agencies, following up on the claims and handling collections, and dealing with any rejected claims. I also ensure that the institution complies with the coding and billing regulations.
What are some of the challenges you encounter at your work
We face many problems in the course of our daily operations. Perhaps the worst is billing errors, which can happen when one has had a long day at work. In some cases, patients end up receiving the wrong bills. This causes many problems for us. Some patients are polite and they enquire about the charges, which we then correct after reviewing. Others are rude and they may end up bring more problems when they raise complaints to the management without our knowledge.
Which organizations or institutions do you often interact with?
I interact with different individuals and groups. Other than the patients and the health staff at the institution, I also interact with both private and government insurers as well as the institution’s legal team.
How are healthcare charging and pricing processes different from those in other industries?
The healthcare industry is complex and the charging and pricing process differ depending on a myriad of factors. The current changes in legislation have affected costs and charges. The private and the government sector often use different pricing processes. The private sector is interested in making a profit and this means that the coverage if often expensive. The government is not interested in making profits but it has limited options. Unlike other industries, the healthcare sector cannot realize significant reductions in cost because of adopting technology. Physicians can only see an individual patient, which means they end up spending the same time they used to. In addition, patients require more tests before making diagnosis and prescribing treatments. This is despite of the increase in the number of medical innovations made. Thus, despite the technological advancement realized, the healthcare setting remains largely traditional in its approach (Marcinko, 2011).
Do you communicate often with insurance provides
Yes. The institution receives many patients and many of them have insurance. I have to make sure that the institution gets reimbursement for all the cases we receive. This involves a lot of communication with different insurance providers.
Do you often use private of government insurers?
We often use both. Patients have different preferences and abilities. Therefore, we have to accommodate all their desires.
What processes do you go through to satisfy the reimbursement requirements?
The process begins with pre-registration, which involves colleting the patient’s insurance information. We have to talk to the insurance company at this stage to get authorization. The insurance company provides the patients coverage information and any other benefits. We do all the paperwork concerning the information we have gathered about the patients’ health and sends it to the insurer. We have to work with the finance department to determine the total charges and the cost that will be covered by the insurance. We have to be accurate, especially when updating documentation, as this will be sent to the insurer. We collect the patients chart and scan it before merging it with the electronic medical records. This process may involve different people depending on the institution. One person may be responsible for the scanning while another is responsible for the coding of the diagnosis. We then send a statement to the patient showing all the billing details, including all the treatments and procedures involved. We review the insurer’s requirement to ensure that the bill is not rejected. We then submit the bill to the insurance company.
How do private and government insurers and payers impact actual reimbursement
Reimbursement depends on the provider. Private insurers mostly use fee-for service but some of them reimburse on a case-by-case basis. The government usually applies a fixed fee for Medicare and Medicaid health programs. Physicians may prefer the private insurers because they can get more money compared to the government. In addition, most people prefer private insurers (Ridic et al., 2012)
Do insurers deny your claims? How often do they do so, and what do you do when that happens?
Yes, this tends to be common, mostly because the patients do not understand what their insurance coverage offers. Contrary to popular opinion, billers do have a cordial working relationship with insurers. Sometimes, the difference between rejection of claims and getting reimbursements depends on the billing statement made to the insurer. This can make all the difference, as the insurers need the patient’s information to determine whether they will pay. Sometime, denials are not justified and this compels us to appeal the case
How have the recent changes in health insurance affected you and how are you able to keep up with the changes?
Working in my profession requires a person to be a keen reader and to keep updated. Support from the institution where one is working is important. My employers support us by ensuring that we go to conferences and any seminars related to our work. In addition, we get newsletters, which contain all health related news. We work with the insurers and we get various insurance related publications. This is in addition to keeping up with all government news relating to the healthcare industry. We have to be flexible in our approach, as this will ensure that we are able to adapt to the necessary changes and implement them in our system. The recent changes in the affordable healthcare act have affected the entire healthcare industry and health insurance providers. Employers are changing their insurance packages to be able to meet the costs (Marvin, 2012). In addition, some services are now offered freely and some costs have reduced. This has required us to review our knowledge of billing. In addition, the matter is further complicated by the fact that not everyone has implemented the necessary changes.
References:
Marcinko, E. D. (2011). Recognizing the differences between healthcare and other industries. Retrieved from http://medicalexecutivepost.com/2011/01/19/recognizing-the-differences-between-healthcare-and-other-industries/
Marvin, B. (2012). Succeeding in an evolving industry – a look at the most influential trends in healthcare payments. Retrieved from http://www.hbma.org/news/public-news/n_succeeding-in-an-evolving-industry-a-look-at-the-most-influential-trends-in-healthcare-payments
Rodoc. G., Gleason, S., & Ridic, O. (2012). Comparisons of health care systems in the United States, Germany and Canada. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3633404/
Last Completed Projects
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