July 01, 2006
5 Minutes With
1) How did you get started in the billing and coding industry? I had originally started working for an Orthopaedic specialist when I was 19. I was able to get on the job training (some offices preferred to train you their way rather than already having experience). After being a secretary for one of the surgeons for about 5 years I ended up taking some time off to have a baby. When I returned back to work I was able to learn medical billing and coding through our office administrator.
2) Have you done any courses? I haven't done any courses in billing and coding. Everything I know has come from years of working in medical offices and asking a lot of questions and also just by jumping into it headfirst. You only make the mistakes once in this business and then you never forget the process for each insurance company.
3) What's the difference between billing for a physician's office and the surgical center? A few of the differences in billing for the facility as opposed to the office is that UB-92's are used in addition to HCFA1500 forms and we use revenue codes to go with our CPT codes. Another difference is that we are paid by groupers, meaning CPT codes are categorized into 1 of 9 groups and paid that group rate. Our surgery center is also AAAHC certified which means we usually have tighter guidelines and more paperwork than most physician's offices. We are audited by them during a site visit every 3 years to maintain our certification. Every "t" needs to be crossed and "i" dotted from the moment a patient steps into our facility until their claim is paid.
4) What are the challenges in staying up-to-date with the rules and regulations concerning outpatient surgical centers? The challenge is making sure that we stay in constant communication with the insurance company. Insurance companies are always changing their demands and regulations. The best way to keep up on them is by calling them, checking their bulletins on the web, attending conferences and workshops, reading everything you can get your hands on, and developing relationships with other billers in the community. Everyone knows something different or has read something that you may have not.
5) What do you like the most about what you do? What I like most is seeing the actual results. Getting my claims cleared in a reasonable amount of time. Trying to keep all the aged accounts under 100 days and by keeping the average amount of days that it takes to get paid down to approximately 70 days outstanding.
6) And the least? What I dislike the most is having to deal with insurance companies. For example when they say that they never received your claim. A lot of insurance companies are outsourcing their customer service to other countries to keep their costs down and it is so frustrating trying to get the people in India to understand why you're even calling or what you talking about.
7) Do you have advise for anyone wanting to bill for an outpatient surgical facility? Always keep a close eye on your claims. Know which insurance companies offer longer timely or shorter timely filing times. If you get a denial notice - act fast so that you can solve the problems quicker and get paid faster. Keep good notes in the computer so you can always go back to them if needed.
8) Anything to add? I think it's funny that people out in the community really think that the doctor gets paid for everything that we charge for. People do not understand that the claims go to the insurance companies, get re-priced and adjusted at times. Then we actually have to write off tens of thousands of dollars on each case sometimes and that the doctor is lucky to just cover his/her cost of the procedure. It takes a lot to run a facility correctly, efficiently and by the book.
Emily Thiriot is a biller for an outpatient surgical facility in Las Vegas, NV.