Duties And Responsibilities of The Medical Billing and Coding Specialist

A Day In The Life Of A Medical Billing and Coding Specialist

The medical billing and coding specialist has many great responsibilities on his or her shoulders. He or she has to monitor the financial charts of the doctor’s office, generate maximum revenue and consequently maintain the financial stability of the doctor’s office.

Hence it can be said that medical billing and coding professional plays critical role in the financial success of any medical practitioner. In lieu of that, we include a step by step walk-through of the sort of things a medical biller is expected to do daily, as well as what needs to be undertaken for each individual file. It can also be summarized as a medical biller’s “to-do” list.

Steps Necessary before the Appointment Day:

The process of medical billing and coding starts well before the patient actually comes to visit the doctor! And it continues until the final reimbursement of payment from the insurance agency.

Any loopholes or miscommunication in this process will lead to delay in generating revenue for the doctor. It is important that the patient’s insurance benefits are verified well before initiating any procedures of medical billing and coding.

To ensure things proceed smoothly,  the patient must be called beforehand and reminded to arrive with all the necessary documents, insurance papers and medical reports. If the patient fails to show up with this, it needs to be documented  – after you inform the Primary Care Physician the patient cannot provide proof of adequate medical insurance coverage.

Office Manager’s Checklist on Appointment Day:

The first thing to be done upon the arrival of the patient is to fill up the detailed patient information sheet or upgrade their information in case they have not visited the physician for more than 6 months.

Also the patient’s necessary documents like personal ID and insurance cards should be photocopied by the medical billing staff. Then administative technician needs to get the patient to sign the Assignment of Benefits form and the HIPAA form so that the medical biller has all the necessary documents required to file the claim smoothly.

After the patient has been checked by the physician it is the medical billing and coding specialist’s duty to collect the co-payment from the patient and make the patient sign the further payment plans.

The Medical Billing Specialist’s Duties After the Appointment:

Soon after the patient’s appointment with the medical practitioner the medical billing professional is expected to make note of the details of the check-up with the patient, their reports, their past reports and also the information provided in the superbills. The medical billing and coding expert is then expected to convert the whole process in an alphanumeric code carefully according to the coding standards.

Please note: the process of documenting the patient’s visit should only be done by the healthcare practitioner as it can be a serious offence if the medical billing staff enters a wrong diagnosis or overview and charges the insurance company for the wrong procedure.

Only then can a medical billing and coding staff can compare the data entered into the superbills and generate the code. While filling certain claims it is also necessary to attach certain detailed reports for easy and quick processing of the claims.

Billing the Patient:

Generally the medical hospitals and institutions that tie-up with health insurance firms are supposed to send the complete medical bills to the insurance industry first and the billing is sent to the patient for any pending residual amount only after reviewing the EOB.

In case the patient has deductible amount to be deducted from the patient’s medical bill, it has to be deducted right away from the medical bills and only after the deductible limit is paid do the insurance companies become liable to pay.

Understanding the Deductible Rule:

If the patient has $300 deductible limit with a 80/20 policy and gets the medical bill of $500, the first $300 is the responsibility of the patient. Of the remaining $200, the insurance firm has agreed on an 80% limit, which means they are responsible for 80% of this amount, or $160. The remaining $40 is also the responsibility of the patient. So in this case the patient is reponsible for $340 of the total bill, and the insurance covers the remaining $160.

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