Virtues of a Medical Biller

medical biller virtues

By virtue, medical billers and coders are privy when it comes to handling sensitive health information that’s why all persons dealing with them should know by heart the importance of HIPAA and live to its standards. In this generation wherein information can be sold and used illegally, malicious intentions are just lurking around the corner waiting for the right time when they can grab a hold of this information and use them to their advantage. When a person signs his name under HIPAA, the responsibility is to protect the patients from harm by simply keeping their records safe but what if the harm comes from within that organization? What if it is an inside job and a person leaks out the information somewhere or someone else? Ethical violation issues in medical billing are not limited to stealing information. It can go simply as misdiagnosing and upcoding the patient’s health status so that bigger claims can be covered. Here are reminders for a medical biller to keep his mind in the moral lane.

Be Honest.

All billable procedures are included in the abstract and are extracted from the medical record. All of the procedures submitted must be included in the medical record as it will serve as hard proof of everything a biller or a coder prepared. Resist the urge to put something that is not there or not documented by medical necessity. Unbundling codes so that each will have a different reimbursement is a no-no. Procedural code should be exactly as the procedure was performed and not something that sounds like it. It is imperative to be objective in coding these things and avoid having personal input on them.

Be Accountable.

A medical biller should take responsibility for the task assigned to him. The steps of the entire revenue cycle management should be seen moving and any delay should be taken with an initiative to inquire at which part is the flow obstructed. If a coder or a biller works in a department for each step of the coding process, clarifications should be asked as to how much wiggle room he can facilitate. Be a team player and always look at the bigger picture which is the revenue for the client.

Bundle Correctly.

Bundling is a payment structure in which different healthcare providers who are treating you for the same or related conditions are paid an overall sum for taking care of your condition rather than being paid for each individual treatment, test, or procedure (Payment bundling – Glossary | Bundled codes are considered incidental to another billable procedure. The practitioner usually fully documents the procedures but there are some procedures that aren’t supposed to be billed separately. The key is to know which procedures are bundled and which ones aren’t. Checking NCCI edits is advised if a coder is not sure about this. If the procedures are considered incidental, they will be included in the bundling edits.

Checking for Errors.

Whether transcription or omission errors, the biller/coder is responsible for bringing them up to the physician’s attention for double checking. Sometimes these errors may range from simple misspelled names to wrong coding in the abstract. Either way, they can cause delays in claims reimbursements and could affect the financial returns to the client.


Paying too much or too little by the payer’s end can be inquired immediately. They are open to talking about these types of disputes which can be remedied. Paying too much, though favorable to the client, doesn’t seem right and should be brought up also. Internal auditing of these things is necessary and will always make a good impression if the biller/coder will show honesty rather than get caught by the payer themselves. Doing so reinforces your integrity with the payer and also averts potential interest payments that may be obligated when the payer finds the error and asks for reimbursement.

Out of Network Penalties and Authorization.

As a biller/coder, the patients should be protected from these out-of-network penalties. This is usually screened at the beginning of every encounter and the front desk should advise the patient of the coverage of his insurance. It is right to assume that most patients are no experts when it comes to their insurance coverages and when a provider treats a patient outside his network, the patient will either face high penalty deductibles or high co-insurance liabilities. A patient is lucky if his plan even considers these out-of-network coverages at all because if not, the patient will shoulder the entire cost of his treatment.

To protect patients from this scenario, office policies should define how out-of-network patients are to be billed. Whenever possible, the biller/coder should verify patient benefits prior to any encounter and explain to the patient the provider’s expectations regarding copayments, deductibles, and co-insurance responsibilities.


The coder has access to both the patient’s clinical information and his or her personal demographic information, such as Social Security number, date of birth, address, etc. It is just right to guard this information as he would his own, not only because of the threat of identity theft but also because of the ramifications of violating the Health Insurance Portability and Accountability Act (HIPAA).

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