Understand the Medical Biller’s Scope of Practice

Many professions have their well defined scope of practice which easily draws a boundary on things which a professional can do and things which he is not supposed to do. There is a clear indication for a pediatrician that he is a child specialist and he is not supposed to help an aged with his health issues. All these professionals including doctors, nurses, lawyers, manicurists and other such professionals have a well defined scope of practice.

Unlike all these professions, the field of medical billing and coding has no strict boundaries to define their scope of practice. The healthcare specialists hire a medical biller and coder in order to save time and money; receive payments from insurance industries faster, invest more time in medical practice and hence improve their own productivity.

General Duties of a Medical Biller:

The medical biller is generally expected to prepare claims of patient’s perfectly after complete analysis of medical records of patients and submit it to the relevant insurance industry. He is also expected to prepare and review and send patient billing statements. He is supposed to answer queries of patients as well as insurance firms related to claim status. He should be expert in resolving patient’s complaints. He is also expected to analyze patient’s financial status and based on that suggest payment options.

A medical biller is also expected to have good hands on computer software, accounting software and maintain daily accounts, review accounts, perform day to day back-up operations. He should also be an expert in making collection from patients and make collections by submitting and resubmitting claims to third party payers over time to time. Maintain good individual discipline in accordance with HIPAA employee manual and also adhere to rules and coding guidelines and other regulations.

One should always remember that medical billers are not coders or manager of healthcare provider’s practice or contract review staff or credentialing staff!

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