Sheila Spieler has been a Managed Care Consultant for over 11 years, specializing in accounts receivables. She routinely interviews and hires medical billers for local physicians. We asked her about medical billing courses and how possible it was to get a job as a Medical Biller/Coder and work at home without any initial onsite time.
"First off Sheila, what IS Medical Billing?"
"Most people who visit a physician have some type of medical insurance with a co-payment. The co-payment is collected at the time of the visit and the balance of the doctor's charge is submitted to the insurance company of the patient. A medical biller submits the balance of the invoice to the proper insurance company for payment."
"What are your thoughts about Medical Billing Courses, specifically the ones that claim "you can work at home" after training?"
"Physicians cannot afford to hire newly certified medical billers to work from their home, they simply don't have the knowledge or experience to properly submit claims. That doesn't reflect on the abilities of a new hire, almost everyone entering a new position needs training and practice in procedures."
"It sounds so easy, take a class and go to work!"
"It's extremely complex. The majority of medical billing classes only cover a small percentage of the knowledge needed to insure correct billing and coding procedures. Most teach basic data input. An established physician can have 10 to 20 different insurance companies, each with specific guidelines, different coverage and coding procedures. A claim submitted incorrectly will be rejected and not paid, sometimes for months! A claim can be rejected because the employer's name was omitted. A claim can be rejected because the procedure is not covered at the doctor's office but IS covered as a referral. There are many reasons claims are rejected, it is the responsibility of the biller to make sure a claim is properly submitted the first time. Even a lot of the doctors aren't familiar with the correct codes for different procedures.
To clarify further, an employer buys coverage for their employees through an insurance company. The insurance company customizes the coverage based on the employer's needs. Let's say you work for employer A and your sister works for employer B. You both have the same insurance company, but the coverage can be totally different between the two. The medical biller would need to know the specific coverage for each employer to properly submit claims."
"If you were considering taking a medical billing course, what would you like to see as part of their instruction?"
Medical Terminology
CPT Coding
ICD9 Coding
DSM Coding (Mental)
An in depth knowledge of HMO/PPO/Network Contracts
Physician Credentialing
Reimbursement/Denial Analysis
"How possible is it to work at home as a medical biller?"
"It's possible but only after hands on experience and whether or not a physician would allow it. The majority of patients are covered through an HMO or PPO plan. A physician would have to be very comfortable with your knowledge and ability to submit claims before they allowed you to work from home. Let's face it, the medical biller controls the income. High denial rates cause hardship on the doctor's practice. The claim has to be accurate, submitted correctly the first time and paid in a timely manner for the doctor to stay in business. Hands on training is the only way you will learn the individual physician's network. An experienced medical biller would probably have to spend less time in a new job updating and training before they could work at home. Physicians should monitor new employees in the beginning. They can't afford to find out 30 days later that a majority of their claims were rejected, it takes much too long to resubmit."
Thanks for all the information, Sheila, it was far too much to print in one article!
All in all, spend time researching a medical billing course and make sure you are getting the best training you can afford. Inexpensive classes often don't teach much more than data entry. Realize you are most likely going to be required to spend onsite time before you can work at home. Medical coders are in demand so the market is certainly a good market and not evaporating. You have time to research and do your homework, it just isn't as easy as those advertisements lead you to believe!
~~~~~~~~ About the Author ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
As manager of Real Jobs Online, JoAnna Gilford is committed to real telecommuting employment and education. She is the author of "Work at Home Workshop: The Truth About Telecommuting" and editor of RJO's daily newsletter. See a sample issue or subscribe at http://www.realjobsonline.com/sample.htm ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
