Medical insurance billing has become much more complicated in recent years. If a doctor is to be paid well for his services, the insurance billing is a very large part of his practice.

There is a lot more to medical billing than just sending a claim in to an insurance company and sitting back to wait for the payment. Each company has its own rules and in order to get paid, we must know them and follow them. How do you learn these rules and where do you turn for medical billing information?

Because it has become so complicated, it has become increasingly difficult to find employees who can handle this time consuming job. A doctor's office is a busy place and his employee may not have half an hour to wait on hold while checking on a claim, for a customer service representative to tell her that the claim is “not on file”.

Since their income, and ultimately the success of their office relies so heavily on the billing being done effectively, Doctors have found it increasingly cost-effective to outsource their medical billing to professionals who can concentrate solely on his billing. If the billing service is being paid on the basis of their results, the doctor is more likely to maximize his receivables.

The medical billing service is going to concentrate their efforts on getting every claim paid when the service is paid according to their results while a billing person in the office is more likely on a busy day to say “Forget it. This claim isn't worth another phone call!!” Unfortunately in most offices this claim will be written off and the doctor will never know.

There is so much involved with billing that most people, including the doctors, don't even realize. The claims have to be submitted properly, and timely, on the correct forms.

If claims are being submitted electronically, reports need to be read and acted upon. When payments are received, they need to be analyzed to make sure they were processed correctly, and then posted.

If there is a patient responsibility after payment is made, then a patient statement needs to be sent. If the claim is denied, or not paid properly, it needs to be handled, and handled quickly. If the denial or incorrect payment is not acted upon right away, you may not be able to correct it.

Some companies only allow a certain amount of time to request a reversal. Aging reports need to be run regularly to make sure nothing else is slipping thru the cracks. Most offices lose thousands of dollars a year due to claims slipping thru the cracks; either processed/denied incorrectly, or not processed at all. If you are not working your aging reports - you are losing money!

But the Medical Billing Services aren't getting rich like the ads portray. There is no simple easy way to do medical billing that the doctor's office doesn't know about.

There is still plenty of work to do to file the medical claims and get them paid. Don't expect that you can start this business without some background or education. There is much medical billing information you need to know to successfully run a billing business.

Medical billing is not a get rich quick scheme. If you are considering starting such a business, you should have a great interest in the field and a willingness to learn much more.

As with any other business you would consider starting, do your homework. Research the field, read as much medical billing information as you can and make sure you know what you are getting into. After all, it takes a lot more than a computer and a kitchen table to do a good job and run a successful business. Make sure you understand what is going to be required of you.

There is a lot of Medical Billing Information out there. Make sure the information you get is from a reliable source. With a growing field such as this, unfortunately there are also a lot of scam artists trying to sell you information that is worthless.

Copyright 2006 Michele Redmond