A medical biller can be required to perform many tasks throughout the day. A patient’s chart that has been coded with the appropriate ICD9 and CPT code(s) is entered into a billing system that is capable of submitting medical claims to insurance companies either electronically or on a CMS-1500 paper form. The charges can be manually entered or electronically transferred from one database to another.
Once the claim has been successfully submitted, most insurance companies can take 14-30 days for reimbursement. However, if there is a problem with the claim, there must be some problem solving involved in order determining why the claim hasn’t been paid. It could be that the ICD9 or CPT codes are incorrect or incorrectly paired with one another. The insurance identification number could be incorrect or the patient isn’t even eligible with that carrier any longer. It can be any number of reasons why a claim isn’t being paid. It is very important to follow up on unpaid insurance claims in a timely fashion because many insurance companies do have timely filing limits. Depending on the denial or reason for non-payment, a formal appeal needs to be submitted to the insurance carrier to be reviewed by a claims supervisor or a medical professional.
Often times, a patient will have to pay part or their entire medical bill. These bills tend to age quickly as medical bills are usually the last to be paid. An effort needs to be made to call these patients to check on payment status to avoid the collection process.
There is also the task of answering patient phone calls to help them understand why they have a bill or explain various charges and denials.
Any delay charge entry and reimbursement will hurt your provider’s practice and it is very necessary to keep current with all aspects of the job. There is never a day that your work is complete, there is always something to do, which makes medical billing such a necessary and in demand job.