Why is Medical Billing Training and Certification Important?

February 21, 2017

Medical billing professionals play an essential role in healthcare. Their work is complex, detail-oriented, and directly affects the financial well-being of healthcare practices. The demand on healthcare providers is increasing, and ambiguity among payers can make claims processing a frustrating process. For this reason, many practices are enlisting the help of trained, certified medical billing professionals to ensure efficiency of their revenue cycle management.

But what exactly are the advantages of hiring a trained and certified medical biller?

Communication Between The Provider, Patient, and Insurance Company

The main role of professional medical billers is to ensure that healthcare providers get paid for the health care delivered to their patients. They are the intermediate between the patient, the provider, and the insurance company. By communicating with all three parties, a medical billing professional manages and arranges payments from payers to the healthcare practice in a timely manner.

Compliance with HIPAA and OIG Regulations

Medical billers work with a superbill (an itemized form that outlines all services rendered to the patient) in order to file a claim with the patient’s insurance company. When creating a claim, medical billers manage information such as the patient’s personal and demographic information, their medical history, the specifics of their insurance coverage, and the details of their care with the physician, such as what treatments were used and why.

Medical billers use this information in order to create and send accurate claims to health insurance companies for reimbursement. It is important that the medical biller is thorough. If the claim does not follow regulations according to the Health Insurance Portability and Accountability Act (HIPAA) and the Office of the Inspector General (OIG), the claim will not be considered complete or compliant, and reimbursement will be denied.

Reduce the Number of Accounts Receivable Days

Following up with insurance companies and patients regarding overdue payments can be time-consuming. Medical billing professionals, as intermediaries, communicate and follow up with patients and insurance companies appropriately and aggressively, if necessary, in order to collect payments for your practice. Having a designated person dedicated to following up on overdue payments significantly decreases the number of days that an insurance claim is outstanding and greatly increases revenue for your practice.

Do You Really Need a Trained and Certified Medical Biller?

The advantages of hiring trained medical billing professionals are directly related to the success of your practice’s revenue cycle management. At 5 Star Billing Services, all of our medical billing professionals have extensive experience in getting claims paid. To learn more about how we can help you maximize revenue for your practice, contact us online or call us at 480-999-0180.

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