Medical Billing FAQ
(Last Updated On: January 7, 2019)

On August 24th, 2012 The Centers for Medicare & Medicaid Services (CMS) announced that it will proceed with a one year delay of the implementation of the ICD-10 coding requirement for medical billing until October 1, 2014. CMS said that the final rule will be published in the September 5, 2012 Federal Register. This ends speculation as to whether there will be further delays in implementing the rule that has been sought by many in the healthcare industry.

The impact will be enormous on the healthcare industry as the current disease classification system contains 14,000 codes while ICD-10 has over 60,000 codes for identifying disease. Moreover, ICD-10 will be broken into two billing groups, physician offices and hospitals. To know the billing for both types of entities requires knowledge of a staggering 140, 000 codes.

An unintended consequence of this decision places a spotlight on schools that teach medical billing. Courses are called medical billing, medical coding or medical coding certification. Schools will scramble to teach the new coding before implementation of the new regulations. New graduates may even see a small advantage in getting a billing position. However, even schools acknowledge that novice billers will have a difficult time getting placed. One industry source put it this way:

“…the one thing that makes a coder truly special will not change: navigating the medical record, deciphering medical terminology, and applying coding guidelines. This is the “experience” that employers are looking for when they say they want one to three years of coding experience. And while new coder’s right out of school will have oodles of exposure to the ICD-10 code sets, experienced coders will have other type of experience – the type that goes beyond looking up a code in a book. That skill will still be coveted by employers.

Also lacking in the curriculum of medical billing schools are other equally vital skills that can only be learned with experience.

First is account management – how often do you follow up with an insurance company? At what point do you involve the patient in the billing problem? When Medicare will not pay what options are there?

Then there is dealing with patients. Patients do not like to deal with medical billing issues. Whether they are contacted just about their copay or an insurance denial, it is as if the IRS has called. They are at once apprehensive and need lots of reassurance to just get information needed to resubmit a claim. Only experience allows a biller to flourish with confidence when speaking to a patient.

While schools produce billers that may be competent in terminology, there is no real world way to teach a novice how to deal with an insurance company. The contact made with an insurance company has only one goal – to deny the claim. Their arguments to the uninitiated seem to make sense and without experience there is no way for a new biller to help a medical practice or facility.

Schools do produce graduates with the technical skills to bill. But billing is part science and part art. The art is putting the technical skills to use in everyday communication with responsible parties – patients, insurers and government agencies. Small and medium-sized practices can quickly gain both parts needed for best billing practices through a billing service. If you are still doubting whether Med Applicaitons are for you – don’t waste your time!

Alan E is a freelance writer/editor with a background writing about healthcare issues.

Leave a Reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.