Electronic medical billing entails as many various responsibilities as medicine itself. Electronic medical billing is often associated with medical coding. What most people don’t know is that, though these two are related, they demand different sets of tasks and responsibilities.

Among its many similarities is its important role in the practice management industry. However, they differ in the job description. In medical coding, the coder selects the proper diagnosis and procedural codes. In the field of electronic medical billing, however, the responsibility requires one to decide on achieving optimal reimbursements, using as his basis, the diagnostic and procedure codes provided by the coder.

Specialists of electronic medical billing are often seen as the income managers of medicine, as electronic medical billing specialists play significant roles by making sure that doctors get paid duly.

The responsibilities of an electric medical billing specialist include - but is not limited to- managing bills and income of doctors. Another responsibility of an electric medical billing specialist is also on handling health insurances. Having an in-depth knowledge of how insurances work is important for electronic medical billing specialist since, these days, patients no longer have to pay cash every visit to their doctors. Now, patients just simply show their health insurance identifications. It is every electronic medical billing specialist’s responsibility to be able to handle and maneuver their way around the intricacies of payments covered by health insurance policies.

Services provided by the electronic medical billing specialists also include both the very basic and the major medical coverage plans like Free-For-Service Plans, Point-of-Service Plans (POS), Preferred Provider Organizations (PPOs), and Health Maintenance Organizations (HMOs). Consequently therefore, electronic medical billing professionals have to be familiar with the different ways with which an insurance company can make its payment.

The Responsibility of Invoicing

Another major responsibility of and electronic medical billing professional is on invoicing. As mentioned, there is a fast-growing number of patients with insurances under HMO wherein the patient simply co-pays for the medical service and the balance of the doctor’s bills will be paid for by the insurance company. It is the electric medical billing professional’s duty therefore, to ensure the invoicing of the patient. Of course, recording of payment entries are executed with software and programs that handle medical billing needs.

Duty Hours of Medical Billing Professionals

Electronic medical billing professionals are usually either employed in large companies or operate independently. Regardless of whether they are practicing privately as individuals or employed in companies, an average medical billing specialist usually works the regular forty hours, covering five days a week, during which, they take care of entries made by walk-in patients in daytime.

Multiple data bases, multiple servers, superbills, synchronization, multiple logins, reports, backups, workstations. Honestly, there is enough to worry about already in managing medical offices. On top of all of that there are multiple codes to remember and refer to?

Medical billing software services have been developed to streamline the medical billing process, not simply by allowing practices to connect to multiple locations and databases in one place (which is quite a feat in and of itself), but also by creating simplified access to important codes to which medical billing must comply. The 2005 CPT code book, updated CPT codes, ICD.9 codes, and all other codes are accessible in the same location as the rest of the billing information, and they are updated automatically from year to year.

When President George W. Bush visited the Midwest during his reelection campaign, he spoke to medical practitioners in several locations and referred to “preventative medicine.” Effective management of records and compliance to codes has become a type of preventative medicine, protecting both the client or patient and the practice. Accessing codes on a simple medical billing software helps to ensure not only an efficiently run medical office but also a secure billing process.

Developments in medical billing software have come to benefit the medical field immensely. Databases allowed business to electronically manage billing and medical history information. Technology also created an IT infrastructure to manage the information.

More recent developments include HIPAA-compliant servers and removal of expensive IT infrastructure. Medical billing software has also developed color-coded appointment making, automatic reminders, and billing generation.

The developments continued to include SOAP note management and transcriptions. Medical billing software can now manage everything in one location, even information from multiple offices and servers. There has also been increased security on the servers and on backups.

Topping off the developments in medical billing software has been access to real-time updated codes, including CPT, HIPAA, HCFA 1500, and ICD.9. As medical companies continue to develop, adoption of a compatible medical billing software should be a prime consideration. Preventative medicine begins with accurate and effective record management and code compliance. As your practice searches through the medical billing software, it is important to take into consideration the recent developments available in medical billing software.

Medical-billing-software is designed to allow you to work on your medical billing needs effectively. Whether you are looking for software that will train or software that will allow you to send out those bills, having the right medical-billing software is quite necessary and needed in just about every medical operation out there.

What should you look for in the medical-billing-software that you need?

• Look for products that fit your needs specifically. You will find a wide assortment of options that will include such things as training software as well as medical-billing-software that will allow you to pull together and send out the bills that you need to.
• You will want the right type of software for your medical establishment as far as insurance information. Some various options in the format as well as in the input needed for the bills is also important.
• What works wonderfully in medical-billing-software is the fact that you have a wide range of products that can work with virtually any system set up out there. That means finding the right program for your system requirements.
• One of the most important things to look for in medical-billing-software is simply how easy it is to use. Not all programs are designed with this intention unfortunately. Look for those that do offer it.
• You also will want to choose the medical-billing-software that fits within your budget as well. While this may seem difficult, you have many options out there to consider and you are sure to find those that will work the best available.

You will find many options in medical-billing-software available to you on the web. You will see that there are a number of great options to consider and there is sure to be more than one that fits your specific needs. Yes, it can be exciting to finally be able to get your billing done faster, easier, and even more accurately when you use great products such as medical-billing-software.

Many health care professionals love working in medical billing and coding. The medical billing career field allows professionals the flexibility to work at home or in a medical facility. And training to become a medical billing professional can usually take less than a year.

The medical billing career field isn’t for everyone; it requires patience, flexibility, and analytical skills to use proper medical codes and bill insurance companies correctly. And it’s a career field for people who want to work in the medical field, but would prefer to work in the administrative side, rather than in the clinical side with patients.

If the medical billing career fields sounds interesting to you, then check out the top ten reasons to work in medical billing and coding.

1. HOT EMPLOYMENT GROWTH FOR MEDICAL BILLING INDUSTRY As you probably know, the medical billing and coding field continues to increase due to a growing need for medical procedures needed by our aging population. Every medical service requires medical billing professionals to relay procedure and cost information to health care insurance companies.

The U.S. Department of Labor recently reported that 8 out of 20 occupations projected to grow fastest are in the health care industry. They also projected that careers in the medical records and health information technician industry should increase 27% or more for all occupations through 2014.

The rise in employment opportunities is great news for trained medical billing professionals. It means that trained medical billing professionals should have job security and lot of job growth going forward.

2. SHORT-TERM TRAINING TO WORK IN MEDICAL BILLING AND CODING Another great reason you should consider starting a career in medical billing and coding is because of the short-term training.

Depending on the school you attend, you can graduate with a diploma in medical billing within a year, and you can get an Associate’s degree in medical insurance billing and coding within two years.

The short-term medical billing program often includes a study of:

* Medical Insurance & Billing Issues
* Medical Documentation and Evaluation
* Government Health Care Programs
* Electronic Data Interchange
* Medical Insurance Claim Form (CMS-1500)
* Ethical and Legal Responsibilities

The Associate’s degree medical billing programs often include a study of:

* Medical Terminology
* Medical Office Management
* ICD-9 Coding
* Advanced Medical Coding
* Medical Billing and Coding Computer Applications

Due to the short-term training, many medical billing schools offer day and evening classes. Please be aware that not all schools offering medical insurance billing and coding will be right for you. Before choosing a school, make sure and read the article on choosing a high quality medical billing and coding school.

3. MEDICAL BILLING CAREERS CAN ALLOW YOU TO WORK AT HOME Many doctor’s offices and clinics don’t handle their own medical billing. They will often hire an outside medical billing agency or medical billing company. Some of these agencies and medical billing companies will hire professional medical billers who work at home to save on costs. And this is definitely an option if you decide on a career in medical billing.

It’s recommended that if you decide to work at home as a medical billing professional, or decide to work as a self-employed medical biller, that you work in an office as a medical biller for a short period of time so that you will gain the confidence and skills of a seasoned medical biller.

4. MEDICAL BILLERS HAVE MANY CAREER OPTIONS Professional medical billers have a solid knowledge of the administrative side of a medical office. Depending on their education and experience, medical billers can move into:

* Medical Billing Management
* Medical Transcription
* Health Care Administration
* Data Collection
* Medical Office Management
* Health Information Technician

And this is just a small list of possible career paths for seasoned medical billing professionals. These jobs will depend on your education, experience, and job market in your local area.

5. MEDICAL BILLERS CAN START THEIR OWN COMPANY Due to the high demand for medical billing professionals, some medical billers are deciding to leave their medical billing job to start their own medical billing company. This is only recommended for seasoned medical billing professionals who can find an assortment of medical offices that can become clients.

Whether you are a person who is thinking about becoming a medical billing specialist or a company looking for a medical billing specialist, then this article is for you. There are several things that you should be aware of in the medical billing industry and I will walk you through them so that you will have the background information that you need to help you make a decision that will best suit your needs. We will first take a look at what it takes to become a medical billing specialist, and then we will also explore the alternatives to hiring a medical billing specialist.

What is a Medical Billing Specialist?

A medical billing specialist is someone who works with a medical office and is in charge of the company’s medical billing. If you desire to be a medical billing specialist then accuracy and attention to detail is a must as you will most likely be in charge of claims processing, charge entry, and billing and collections. However, most medical offices will hire someone to do more than just be in charge of medical collections. They will want someone to be more of a medical assistant as well. Job duties will then expand to include things like:

• Accounts payable, payroll and banking tasks

• Prepare and maintain patient charts

• Schedule appointments

• Receive and make phone calls

• Perform insurance verification, pre-authorize and referral duties

How do I become a Medical Billing Specialist?

Most businesses will require you to either have several years of experience working as a medical assistant or some kind of advanced certification as a medical assistant. There are several programs out there to help train and educate you to become a medical billing specialist. By doing a Google search for “medical billing specialist” you should be presented with a lot of options to help guide you to becoming a certified medical billing specialist. There are programs that you can complete online and at your own pace. Others require you to attend some classes for a couple of semesters. In my search I found many of the programs to cost around $1000 but some were as much as $6500.

Is it worth it to become a medical billing specialist?

The medical industry is experiencing a tremendous demand for individuals knowledgeable in medical office operations. Medical billing specialists are one of the fastest growing professions and are currently a very high demand job. According to the American Medical Association, there are over 1.2 million Medical Specialists in the United States. If you are interested in this kind of profession, it would be to your advantage to learn more about it.

What about outsourcing?

Because of the time and meticulous accuracy that medical billing requires, there are some companies that only specialize in being a medical billing specialist. Medical offices outsource all of their medical billing practices out to these companies rather than hiring an in-house specialist to manage their medical billing needs.

Is there software that can do everything a Medical Billing Specialist can do?

There is yet another solution to managing your medical billing needs. Companies such as AdvancedMD provide a software solution to be your medical billing specialist. An advantage for a medical office to go this route might be that it will be cheaper in the long run to have software to manage all of their billing needs. Also the electronic medical billing specialist will be less prone to errors unless they are due to a human entry error.

As you can see there are many solutions to help you to better manage your medical office. There are advantages in every category; it just depends on what will be the best fit your office. If you are thinking about becoming a medical billing specialist, I feel that it is worth looking into as it is a very high demand job. However, you should be aware that with alternatives out there, like outsourcing and medical billing software, you might have a little competition.

In the last few years there has been an increase in pressure in the medical profession. Many people do not have medical insurance to pay their medical bills and this has resulted in medical offices having less money for hiring employees. Because of this, many doctor’s offices have started using third-party electronic medical billers to help improve their cash flow.

Other offices are purchasing electronic medical billing software so they can upgrade their own billing system. Being fully automated helps to cut down on office personnel and is more efficient than the former billing practices. The medical billing software comes with options such as printing the bill with late charges or just showing the number of days the bill is late. There are several software companies which provide billing software; you just need to know what features you need to fulfill your office requirements.

Sage Software: This company offers a billing software package which can be customized to suit the needs of the company. There is a section provided for address changes or to announce an upcoming event. It also has a feature to provide collection letters or letters reminding someone of their appointment time.

Collaborate MD: This software offers medical billing which uses the Internet for its day to day operations. The small monthly fee is affordable and the company always performs back-ups each day. This insures that you will not lose all of the valuable data which is stored in the system. With the click of the mouse you can view the reports needed to tell you what is going on with your business. This frees up time for the office staff since they do not have to spend hours running reports.

Medical ProClaim: This is a powerful program which is windows based and provides top notch medical claims processing. There is more than one version to choose from including medical practice, anesthesia, and dental. The low price for this software with its extensive features can help the medical practice office save a lot of time and money.

Choice Medical Billing Service: This is an outside medical billing firm that charges a percentage of the paid medical claims. Their goal is to provide a dependable billing service that has a high rate of success. They are not paid unless their clients get paid which can help reduce the costs of repeat billing. They offer a 100% guarantee that you will be satisfied with their service.

No matter what route you choose to take, electronic billing can help speed up the process of billing claims. You can choose software which is installed on your office computer which requires very little input from the staff. This software also compiles the reports needed for accounting so your staff has more time to perform other duties. This software is usually fairly inexpensive and provides updated versions for a nominal fee.

By choosing an outside firm or individual to do your billing you will be able to employee less staff and cut the costs of everyday operations. By having fewer employees you will not have to pay the salary or the benefits which are associated with each employee.

Online Medical Billing and Coding Specialist Schools teach courses that focus on the administration of Medical Billing and Coding for purposes of proper categorization of medical procedures and accurate billing processes. Students of Medical Billing and Coding will be prepared with those skills essential for Medical Billing and Coding processes and for Certified Medical Coding and Billing Specialist examinations for certification.

Online Medical Billing and Coding Specialist Schools train students specifically in the universal language that was developed for the purpose of streamlining medical insurance claims that ensure correct reimbursement from insurance companies for services rendered. Every symptom, diagnosis, procedure, and treatment has been assigned a numeric code that informs the insurance company which services were administered in a hospital, a doctor’s office, a clinic, or other medical facility. This numeric language is used by Medical Billing and Coding Specialists to establish the exact services provided. The Medical Billing and Coding Specialist determines these codes and makes a selection based on information provided by the care provider, then processes the claim.

Online Medical Billing and Coding students can expect to study medical terminology, anatomy and physiology, reimbursement methods, law and ethics that apply to medicine, information management, and practices of various office environments.

Additionally, courses in Medical Billing and Coding will prepare students with professional skills that will allow for management of records, preparation of insurance forms, correct filing of claims, and for billing insurance companies for services rendered.

Responsibilities of a Medical Billing and Coding Specialist involve the accurate completion of billing and medical claim forms, appropriate billing, and good understanding of individual insurance company policies and procedures. Medical Billing and Coding Specialists can expect to work for hospitals, medical practitioners, medical clinics, and physical therapists, where efficient and well-prepared Medical Billing and Coding Specialists will manage billing and coding processes.

3M’s advanced software tools and services are designed to capture, classify, and manage accurate healthcare data. Our revenue management solutions include a wide range of services from 3M Consulting that include chargemaster, strategic pricing, coding validation, and DRG and APC assurance services. Our outpatient software solutions include 3M[TM] APCFinder[TM] software, APC[TM] Grouper Plus software, and 3M[TM] Ambulatory Revenue Management software, which provides a single outpatient database for ambulatory reimbursement, performance management, and compliance allowing you to review outpatient data pre-bill, at-bill, and post-bill.

Your billing software should provide you with a summary report that will show where unpaid services exist in your practice (figure).

The example illustrated here begins with a list of “Charges on Hold.” Each of these charges is annotated with a reason why the charge has not been filed.

The next category (”Collection”) lists charges that are ready for collection.

The “Contracted Variance” section lists those claims that were not paid according to the terms of your contract with the carrier. In the first example, the payer did not pay $104 as contracted. If the patient does not pay the difference between $104 and $69.80, the carrier must be notified that it is in breach of contract.

The figures in the “Denials” category are annotated with the reasons that have been given for the denials. These are self-explanatory. Your software should keep track of your success and failure in appealing these denials so that your staff can learn the most effective, carrier-specific way to appeal.

Charges on Hold
Charge: 55161 with Procedure: 69436 is considered       1      31.35
comprehensive with one or more other charges on
DOS: 3/10/2005
Charge: 55162 with Procedure: 69210 is considered       1       4.58
comprehensive with one or more other charges on
DOS: 3/10/2005
Missing/Invalid FormType for claim: edit carrier to     2     164.99
correct trading partner setup
Missing/Invalid Hospital AdmitDate (required when       4     608.71
POSCode is 21,31,51,52, or 61)
No BaseFee for claim                                    1       0.00
No FilingOwnerAddressl for claim                        1       0.00
No FilingOwnerPolicyNo for claim                        2       0.00
Outstanding profile change request. Please check        5     304.46
Profile Management Workfile screen

Workfile Total:                                          17   1,114.09

Collection
Campaign reached collection state                      50   1,804.01
Campaign reached collection state                      26      47.61

Workfile Total:                                          76      1,852

Contracted Variance
Allowed amount did not meet contract amount of          1      69.80
104.00 with variance of 0.00%
Allowed amount did not meet contract amount of          1      82.90
90.00 with variance of 0.00%
Allowed amount did not meet contract amount of          1      12.28
133.90 with variance of 0.00%
Allowed amount did not meet contract amount of          1       1.58
15.00 with variance of 0.05%
Allowed amount did not meet contract amount of          1     263.67
327.80 with variance of 0.05%
Allowed amount did not meet contract amount of          1      72.53
419.45 with variance of 0.00%
Allowed amount did not meet contract amount of          1      20.96
99.03 with variance of 0.05%

Workfile Total:                                           7     523.72

Denials
Held by system due to allowed amount of zero            1   1,760.00
Procedure not payable separately                        3   1,495.00
Additional info needed to process and pay claim         3     712.94
Assistant surgeon fee not payable by this carrier       1    -40.00
Claim not covered by this payer/contractor. You must    6     851.23
send claim to the correct payer/contractor
Claim received but still pending                        1       0.00
Electronic Remit Denial                                 1       0.00
Need medical records to support claim                   4      42.42
Needs refiled with remit                                1      20.00
Patient cannot be identified as our insured             1       0.00
Procedure not payable separately                        1       0.00
Claim forwarded to the medical group                    1     130.00
Duplicate EOB, no previous response to claim            2   1,165.00
Electronic Remit Denial                                 1     130.00

Workfile Total:                                          27   6,266.59

SACRAMENTO, Calif. — LexisNexis Examen Inc., an industry-leading provider of legal spend management solutions, announced today that Health Net, Inc. has elected to extend their use of the LegalPrecision(R) solution. The use of LegalPrecision, one of the legal spend management products from LexisNexis Examen, allows Health Net to quickly and electronically process their legal invoices from outside counsel.

“The ability to review invoices on line at any time and from any place has helped us to accelerate our invoice processing,” said Cory Sotolov, manager of Litigation Administration at Health Net.

This agreement extends Health Net’s use of the LegalPrecision solution for another three years.

“We’re pleased that Health Net has continued their relationship with LexisNexis Examen,” said Kipp Johnson, vice president and chief operating officer of LexisNexis Examen. “We believe our e-billing and legal spend management solutions help our customers achieve significant cost savings as well as efficient processing.”

LexisNexis Examen Inc. is an industry leader in providing innovative, easy-to-use solutions for streamlining business processes between organizations and their outside counsel. Combining in-depth knowledge of the legal industry, state-of-the-art technologies and world class service, LexisNexis Examen offers reliable, affordable web-based legal spend management solutions to a growing list of Fortune 1000 customers. Based in Sacramento, CA, Examen has been providing solutions to insurance claims and corporate legal departments since 1990. After being acquired by LexisNexis in 2005, Examen and the LexisNexis CounselLink application are now part of the LexisNexis productivity tools suite that help in-house counsel excel in their dual role as legal advisor and business manager.

About Health Net, Inc.

Health Net, Inc. is among the nation’s largest publicly traded managed health care companies. Its mission is to help people be healthy, secure and comfortable. The company’s HMO, POS, insured PPO and government contracts subsidiaries provide health benefits to approximately 6.4 million individuals in 27 states and the District of Columbia through group, individual, Medicare, Medicaid and TRICARE programs. Health Net’s behavioral health subsidiary, MHN, provides mental health benefits to approximately 7.3 million individuals in all 50 states. The company’s subsidiaries also offer managed health care products related to prescription drugs, and offer managed health care product coordination for multi-region employers and administrative services for medical groups and self-funded benefits programs.