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Doctor billing format for Purchasing

have you been learning about the role of a medical biller or hearing about this job as medical billing or revenue cycle management and have zero clue what the heck that means and maybe you stumbled across our long form video and said an hour that's a lot of conversation around what a medical biller does so today I want to have a quick conversation with you around the types of things that we find a medical biller typically does in a medical practice but before we do my name is Jasmine welcome here to Anda University I the proud mama around this space I have more than two decades of experience in the business of healthc care and in this space My Hope Is that you find alleviation of the stress and confusion in the business of Health Care so that you can feel yourself more focused more fulfilled and enjoying the process while we improve the delivery of our patient care so listen my friends I know there are a lot of you who are coming into this world of healthare and have zero clue what exactly takes place in the US healthare system the world of medical billing so we're going to talk today exactly what does a medical biller do so a medical biller can the type of role of medical biller can be unique from organization to organization today we're going to talk specifically around a typical job of a medical biller in a medical practice whether the person Works within the four walls of the medical practice or is working from home and so when we talk about a medical biller responsibility sometimes they might be backup support if they're in the practice extension of the practice to do things like answer phone calls and support our patient flow so that's a little bit of a side potential responsibility that might come up for you if you are operating in a medical practice and very closely knit group that needs some backup support so know that that's possible but beyond that a typical responsibility of a medical biller is going to take place after the patient visit happens and the patient now has charges and diagnosis and claim data that needs to go or claim information that needs to go to a third party or maybe even needs to be build directly to the patient themselves when we have a claim ready a medical biller job is to make sure that claim makes it to the insurance but before that happens some things that the medical biller might be responsible for is reviewing that claim for completion making sure the information is present and um complete by the parties that are involved so that might be the front desk that might be the patient themselves it might be the provider clinical staff and so we're going to make sure that data is complete and has an opportunity of making it to the the third party successfully the first time around and so when our medical biller is reviewing that we typically call that some sort of reconciliation process when that biller does those types of things oftentimes they might also look at the patient payments that were made making sure that those payments were properly posted to the patient's account making sure that the monies are appearing ing to the right process whether it needs to be attached to that particular claim or date of service those types of functions are also responsibilities of the medical biller making sure the claim goes to the insurance company in a timely manner is a responsibility of the biller so getting the claim out the door whatever means possible whether that is some way that they need to go on paper meaning they're printing a manual claim that gets mailed to an insurance company or faxed to an insurance company or they might be submitting things electronically their job is to make sure that it makes it to those individuals successfully so when that claims go to the third party electronically there is a responsibility of making sure that if something comes back by way of what we call rejections those things are reviewed and resolved and the claim goes back out the door so that is a responsible responsibility of the medical biller as well and so after the claim has been processed by insurance company sometimes there are things that might be requested so there might be a letter or some sort of denial that comes back that asks for more information and in that case our medical biller is the one responsible with responding to those types of requests and issues that might have Arisen after the claim was reviewed by the insurance carrier so that might be sending more information that might be going into our patients EHR to make sure they provide medical documentation or operative reports which is reports about surgeries that are being being done so that is a responsibility of our biller they need to make sure that the claim is not just submitted but also that the insurance carer has what they need to fully process that claim after the claim is processed and hopefully payment comes back the medical Bill's job is to make sure that payment gets applied to or posted to as we call it the patient's account correctly so their job is to take the patient the the insurance payment and make sure it gets into the patients account so that we hopefully have resolved that claim or the claim is now going to be zero or close to zero and if there's a responsibility of our patient left over something that the patient now needs to cover some co- insurance or deductible which are terms that if you are not familiar with you should totally check out our uh language of medical billing course or you can check out some of our other videos here on the channel but the the patient responsibilities might need a statement generator so the medical biller is also the one responsible for sending our patient statements in most cases and making sure that those balances are correct and sometimes even ask answering those questions from the patients when they call in with questions about their balances and reasons for their balances so let's rewind and pretend like insurance company got the claim but did not process the claim for any reason when the insurance company doesn't process the claim the follow the what the next step would be is for the medical biller to see that this claim is still outstanding and they're going to then do followup which means that they're going to try to call or reach out to the insurance company electronically to find out what happens to the claim so that is what we typically call An accounts receivables or an AR process and that type of work is the responsibility of a a medical biller to follow up and find out what happened to the claim and why it was not paid or make sure the insurance carrier didn't lose the claim didn't get lost in the in route to the insurance carrier so that they might have to do things like resubmit or appeal the claim which is when they are writing some sort of communication to ask for the insurance carrier to reconsider what they determined on their first or their previous processing of the claim all right so process the appeals process and that accounts receivable followup is the at the heart of why an effective medical biller is important because we want to make sure that we don't have money just sitting on the table and so when we have an effective medical biller they are spending a lot of time and attention on that area and hopefully are doing their best job to streamline some of the other busy work that can happen in health care so medical biller responsibility to ensure that the insurance carrier that the third party has processed our claims correctly and that they are reconsidering them and if for some reason they don't and we did something wrong with our billing the biller job is to consider what the next step is and whether that is something that needs to be written off because it was buil incorrectly and it was something that was not supposed to be build or or properly build on a claim then they might be writing off which means that they're eliminating a balance that um needs to be removed by way of using a special code in that software um or they're doing something else like uh sending a patient a statement because that is possible with the relationship with certain carriers that um may be listed in your contract that you can send this uh claim to our patient after the insurance carrier has denied it so it's very important to know what I mean about that a little bit more deeply before you have the biller just kind of dive into that type of scenario however a medical biller when they are effective knows exactly what the next The Best Next Step will be because they won't want to violate your contract and your commitments to um to writing off things that were denied by the insurance carrier so that leads me to my next thing is our responsibility of our Biller is making sure that they stay up to date on the policies and the rules around this Health Care revenue cycle and the contracts that they have that your practice has or the practice that the medical biller is working has with the third parties and insurance carriers it's very important that everybody is U up to speed and stays close to Industry updates and so that is why groups like our medical billers network is are super helpful because it can help help medical billers work together and collaborate when they run into issues that might be a little confusing and hopefully they can be able to problem solve together and um and not be just trying to throw things up against the wall in hopes that something sticks so our hope is that with the medical billers Network that our community of medical billers are working uh compliantly and collaboratively to help improve the delivery of patient care and hopefully alleviate their stress and confusion that they're experienc in the in the business that they're doing in healthcare so with that said if you're interested in joining our medical billers Network please make sure that you visit the description box below it's a Facebook group it's totally free to join the the medical billage Network we just ask that you review the questions there and um and consider all of the questions that we have or the comments we have or commitments we have to be very um important because we want to make sure that this place is this Facebook group is an environment that is supportive for all and so that means not allowing spammers or disrespect to take place in that environment also if you're someone who's interested in becoming a medical biller now that you have heard what the medical biller does then you don't want to miss out on the courses that we offer we're constantly adding to our course um catalog so go ahead and take a look Below in the description box and see if there's something in our course catalog that might support you in your journey so with that said I look forward to seeing you guys again soon and thank you so much for hanging out with me I'll see you in the next video take care