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Medical Billing and Coding? Lucrative? - You Bet

Updated on May 14, 2017

Medical Billers and Coders

Medical billers and coders are an integral part of the health insurance industry because they are responsible for turning healthcare provider services, performed on patients, into bills to be paid for by the patients insurance company. Doctors, surgeons, anesthesiologists', you name it, all need to get paid.

So where do you start? Well, building a solid understand to the basics of medical billing is the first step. Doctors can always call and complain to any insurance company stating why their claims were denied, underpaid, and hey, sometimes doctors call and complain about their claims being overpaid as well. The law allows this so don't worry but just make sure you bill the health plan correctly because you don't want the doctor calling and complaining about a claim that was denied because it contained the wrong information.

Health plans come in many names and forms, you know Kaiser, a provider of commercial health insurance, and then there is Medicare, which is a federal insurer, mandated by insurance laws individually by state, for example, Medicare might cover a flu shot in the State of California for a patient up to once per year at a flat rate of $5.00 whereas, one state up, in the State of Oregon, the Medicare federal law for allows Oregon to pay $24.99 but the claim must be submitted to the health plan within 3 months to be considered for payment. These are basic examples, the Medical Billing and Coding 101s, that are common knowledge.

Here are some basic principles to medical billing and coding:

  1. Different types of health insurance claim forms
  2. Different bill types i.e. inpatient, outpatient, adult day health care, dialysis, etc.
  3. Provider dispute resolution process (PDR) claims - This is when doctors call and complain about why their claims were denied when it should've been paid.
  4. Coordination of benefits if the patient has more than 1 type of medical insurance
  5. Do not bill for services that are not covered or your claims will be repeatedly denied as "services not covered."
  6. Your doctor is licensed because health plans don't pay for unlicensed doctors, clinics, hospitals, etc.
  7. Your patients health insurance is valid and not expired because health plans will not pay for services performed if the members insurance has expired with the health plan.
  8. Filing claims on time i.e. claims must be submitted to a payor within 2 months of the services performed or payor can deny such claims.

Medical billers and coders start out at $17/hour in most states and if you know how to bill a certain specialty, like anesthesia claims, they pay upwards of $25/ hour.

Start your career today as a medical biller and coder!


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