Practice Management Company
A practice management or a billing company may also hire their own medical billers and coders. One advantage of this is the various and wide administrative support. Saying this, a newbie in the field of medical billing and coding is advised to start with this kind of setup since he will get all the help that he needs in doing his tasks. Mutual work feedback are encouraged here and will give a sense of teamwork which is good peer practice for a new coder and biller since he may know some off-the-book techniques that can make his work efficient and productive and methods that are specific to his task alone. Bigger companies have more structured guidelines and procedures on how to do things which can serve as a pattern for a new coder/biller. Areas of specialization are also available when working with bigger practice management. For example, if a person is assigned to general surgery, he will know most of the codes for procedures and diagnoses for that area. However, continuing to work for a long time in a specific specialty may limit the skill of a coder and biller since exposure is only limited to such. Medical coders are hired mostly to do the coding since the system is universal but the billing system, on the other hand, varies per institution and may not work uniformly for all. A more focused on-the-job practice for a certain company may be required for a biller but his previous experience on the job will give him an advantage as a skilled biller.
Medical Billers and Coders in an Insurance Company
Medical coders on the side of the insurance payers are called claims processors. Though most of the claims right now are processed by computers, a human touch may still be necessary for the process to efficiently identify certain errors brought about by the system. A claims processor is also a coder with solid billing knowledge and acts on behalf of the insurance company and performs its obligations.
How does a claim processor scrutinize a claim?
Once a biller has submitted their claims to the insurance, the claim processor will examine each claim carefully and validate them. He will do this by looking at the insurance coverage of the patient first and determining the level of processing for the claim. He also has access to the details of the medical provider involved in the claim such as the NPI or the Tax Identification Number. Once everything fits accordingly and everything adds up, the payment will be issued accordingly. If clarification or supporting documents are needed to issue the payment, the claim may be denied temporarily and will be sent back to the provider for completion. This however is a nuisance to the provider who has no choice but to comply or else, payment will not push through.
Other facilities that need medical billers and coders
1. Skilled Nursing Facilities – with an increasingly older population in the US, nursing care facilities such as nursing homes require a lot of manpower. Aside from the skilled nurses, there’s also a need for medical billers and coders to interact with Medicare/Medicaid to process the claims for the services rendered.
2. Outpatient Clinics – in a non-emergency situation, people can go to outpatient facilities for their medical consultations and there are actually more people who are not in a life-threatening situation hence more workforce is needed in this type of workplace.
3. Home Facilities – Long-term care facilities are in constant need of medical billers and coders since most patients here are with chronic conditions. The same patients are usually seen and therefore the coders are already familiarized with their assigned diagnosis codes.
4. Government agencies – of course, the entire country itself needs more skilled medical billers and coders because of the aging Baby Boomers generation
Working At Home
Working off-site has been offered already and is actually a good opportunity if someone can get it. Everything is in the comfort of the home but sensitive patient health information is handled therefore the biller and coder should be mindful and cannot just work anywhere like a coffee shop where these details are exposed to other people. This sensitive patient information can be hacked and sold to other people and that itself is a violence of the HIPAA responsibility of the coder. The trouble with working from home alone is that the coder should be independent with minimal supervision to work. Technical support is not as efficient and work feedback is not in real-time.
Ideally, a new medical coder is not advised to work initially from home. Remote coding is for the experienced coder. These coders need less assistance and fewer clarifications on the matter while novice coders always have this big question mark over their head if whether what he is doing is right or lacking or whether is it enough for the day. My RCM Group hires expert seasoned medical billers and coders offshore and are all HIPAA certified.