Date Posted: Wednesday,
August 30, 2023
Medical billing is not always an easy profession. Medical billers must interact with the medical care triad: the provider, the patient, and the insurance company. Medical billers face audits, upset patients, disreputable insurance companies, and fellow medical billers. It is necessary to be able to cooperate with each.
The following medical billing values are important values that every medical biller should possess:
- Loyalty: A medical biller is loyal to his/her employer, patients, and insurance companies. The biller sends a correctly coded claim to an insurance company within the time limits established by state and federal laws, posts the payments correctly, sends an accurate medical bill to the patient, and posts that payment, leaving the patient with a zero balance. Loyalty means that if a claim is overpaid, the medical biller returns the overpayment, and when there are delayed claims and underpaid health benefits, the medical biller disputes them—and does not give up.
- Responsibility: A medical biller is responsible to the provider and the patient. Without the patient, the provider cannot conduct business, and without that responsibility, the provider will likely go bankrupt and out of business. Medical billers are obligated to help ensure the financial health of the provider, which helps ensure the health care of the patient.
- Respect: A medical biller shows respect to the medical care triad, as well as the medical billing process and profession. The medical biller is not dishonest and does not allow other medical billers to be. When a patient has an issue with their medical bill, the patient will contact the provider through the medical biller. The medical biller provides the patient with detailed information that explains the medical bill and helps them understand it.
- Selflessness: A medical biller's job is to provide the best medical billing that patients deserve, putting patients before themselves. There may be times that a provider asks the medical biller to work overtime to resolve a billing issue, such as to prepare for a meeting with an insurance company that owes the provider several thousands of dollars in denials, reduced payments, and lost claims.
- Honor: The medical billing profession is a fairly new profession. The first medical billers worked to make the profession honorable by following proper training, sending correctly coded claims in a timely manner, disputing insurance companies that denied claims or paid less than the law and contracts required, and they were honorable in their actions with their employer and the provider's patients. This value of honor in the medical billing profession protects against insurance companies attempting to degrade the medical billing community. When walking into a meeting with an insurance company executive or a state or federal regulatory agency, the medical biller can hold their head high, knowing that they are doing an honorable thing. Once honor is destroyed, it can never be returned as doubt replaces honor.
I have personally been involved with a meeting between a state and federal regulator and an insurance company. I provided clear cut evidence that the insurance company was not telling the truth, the whole truth, and nothing but the truth, and the insurance company was caught in a blatant lie. I provided proof of my honor and my truth, whereas the regulators lost all respect and honor for the insurance company. My honor and truth won my provider hundreds of thousands of dollars.
Honor is everything in our profession.
- Integrity: Integrity means we do our job the right way, we do our job the legal way, and we do our job the moral way. It only takes one poor decision to destroy a medical biller's integrity and with it the medical biller's reputation. I once knew a doctor who was caught lying, stealing, and cheating, which resulted in the doctor losing her medical license. After five years, she went before a state and federal hearing to request her license be reinstated so she could start a new medical office. The state and federal agency would not approve her request unless the regulators had proof that a different medical biller was honest and agreed to spend the following three years inspecting the provider's documentation to ensure that she did not repeat her past mistakes. After being approved by the regulators for meeting their requirements, a medical biller investigated the provider as requested, providing monthly reports regarding the provider's integrity, and after a few years, the doctor's license was reinstated. As a testament of the medical biller's integrity, she was hired by the doctor on a permanent basis.
- Courage: Courage means you do not fear or worry about danger or adversity. Some insurance companies, when they realize that you are doing what you are supposed to be doing-you are disputing the insurance company's denials, their lesser claims payments, and denials of the appeals-will have their lawyers threaten you and your provider with a lawsuit or to file a complaint with state regulators that could prompt revocation of your doctor's medical license. A medical biller without courage will give up, unable to speak up and stand up for their provider. Without courage, the insurance company wins, and once they win, they will not have any issues continuing with their demands and causing you and your provider to go out of business. But, if you demonstrate courage and fight back, the insurance companies know that you will not give up-they will.
I was speaking to a group of medical billers, and during a break, one medical biller told me that an insurance company would not let her fight back. She lacked courage, which was evident, because I decided to fight back and I won. When she gave up without a fight, the lack of courage was contagious and everyone else in her practice also gave up. Three words that medical billers need to remove from their dictionary are: "I give up." Medical billers do not give up and do not accept defeat—no matter the odds. And remember, while a lack of courage is contagious, courage is, too.
Medical billers are experts and must hold themselves to high standards of professionalism. We medical billers are the guardians of the healthcare profession. Statistics show that there are currently 134,966 medical billers and 1,077,115 doctors in the United States, with the CDC reporting over 1 billion physician office visits alone in 2022. These doctors cannot effectively perform their job without us. Medical billers are valuable to the healthcare industry.
We are billing strong; we are medical billers!
Steve Verno, Professor of Medical Coding and Medical Billing.