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Care + Career

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Current Issues in Medical Billing

"The medical billing and coding profession is dependent on detailed knowledge of complex billing, coding, and reimbursement information. Success requires both critical thinking skills and ongoing education to keep up with the latest industry requirements. Medical billing and coding professionals need to be savvy about payer specific requirements, billing challenges, changing legislation, and be able to understand the different reimbursement methods”. All of these topics are discussed in the latest NHA CE article, “Current Issues in Medical Billing". 

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About the Series

Current Issues in Medical Billing:  This article is an overview of some of the challenges in medical billing, and how to address them. It also takes a look at the current trends for reimbursement and looks at highlights of new billing legislation for 2019 and beyond.


About the Author

Lisa Roan, CPC, CPB, CRC, CPC-I, B.S. Health Care Administration

Coding Revenue Consultant, Roan Enterprises

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  • 20+ years’ experience in medical reimbursement & coding
  • Certified Professional Coder (CPC)
  • Certified Professional Biller (CPB)
  • Certified Risk Adjustment Coder (CRC)
  • Professional Medical Coding Instructor (CPC-I)
  • Bachelor of Science in Health Care Administration
  • Coding & Reimbursement Consultant for the Inland Empire Foundation for Medical Care

What is the difference between a medical biller and a medical coder? 

Medical billers have multiple responsibilities related to the reimbursement cycle. They might be posting charges, submitting claims, or posting payments to patient accounts. Medical coder tasks are more specific to assigning or assuring correctness of codes, based on the documentation.

What are some personal qualities that are essential to posses thrive as a medical biller? 

Some of the personal qualities that allow medical billers to thrive are a willingness to dig deeper and understand the how’s and why’s of a process or problem. The billing cycle involves other people in different departments, and the successful biller is one who can not only determine how a problem happened, but to also identify and understand how to correct that problem for the future.

What are some common pitfalls regarding medical billing? 

A common pitfall in medical billing is not billing the correct insurer. Many patients have more than one insurance, so billers need to understand which insurance is primary. Other pitfalls include not obtaining required pre-authorization for services, and not collecting patient co-pays or co-insurance amounts.

Medical bills are often the last bill that consumers pay. How can we change that mentality? 

Communication is key to changing the mentality that medical bills can wait to be paid. It is important to explain the patient responsibility portion of the bill to the patient, and the office policy regarding the payment. Once a patient understands how much the bill will be and when it is due, it is easier for them to pay. Payments should be collected when the service is rendered, whenever possible. For amounts that are billed to the patient, the key consideration is convenience for making payments. Give patients easy options to choose from. Pre-paid return envelopes, toll-free numbers with no hold time, and on-line payment portals are great options to make paying medical bills more convenient.

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We’re grateful to have experts like Lisa Roan contributing valuable content in our CE series. We believe there’s no better source of learning than from the men and women who are actively working — and leading — the industry today.

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Before completing NHA CE, we recommend checking the rules and regulations of the licensing or regulatory agency for your state, in case there are different requirements.

Topics: continuing education, Insider, industry news, regulatory updates, CBCS