Role of a Biller/Collector
Understanding Medical Terminology and Billing Codes
A home health care biller must be able to understand medical terminology and billing codes and use them correctly on claim forms.
Biller’s Duties
- Transmits RAPs
- Transmits Finals
- Transmits/Processes Claims
- Pre-billing Audits
- Copies Notes, etc.
- Medical Records
- Giving them input and collecting any new files and information for billing
- Filling out insurance forms & ensuring they are properly coded before claims submission
- Processing files
Claims should go out either daily, every other day, weekly, or bi-weekly depending on the agency’s size and claim volume.
Ideal billing staff qualities
- Self motivated/self starter/ self directed
- Problem solver
- Good communicator
- Accountable
- Team player
- Detail oriented
- Organized
- Conscientious of policies & risk
- Dot I’s & Crosses T’s
- Committed
- Stable/reliable/attendant/integrity
- Unafraid of technology
- Quick learner
- Willing & able to do what needs done
- Unafraid to try new things
- Unafraid of constructive criticism
- Flexible & adaptable
- Don’t like change
DICS
- Hi C’s
- Personality Types
- Perfectionist Pattern
- Objective Thinker Pattern
Other tests that can be used:
- Career Hunter
- Sokanu Career Test
- Myers-Briggs Type Indicator Instrument
- Red Bull Wingfinder
- John Holland’s Self Directed Search
What biller and collectors need to succeed
- One on One Training
- Periodic billing operations review
- Have a cycle
- Establish daily/weekly/monthly routines
- Need measurable outcomes
- Loves healthy competition
Typical billing problems
- Poor/Unorganized billing tracking
- Pre-billing audits
- Poor supervision/management oversight
- Limited or no billing training
- Poor communication between billing & clinical staff
- Inadequate time spent on follow-up (20%/80% rule)
- Poorly implemented billing routines
- Lack of accountability
- Inadequate knowledge & functionality of software
- Analysis Paralysis
- Not checking receipt of claims with Medicare
What does a Successful Biller Look?
- Timely claims submission
- Great communicator
- Gets Training Constantly
- Vast FISS/DDE knowledge
- Established processes
- Has a routine
- 98% first pass rate
Collector’s Duties
- Works Medicare T, D, R, & I status claims
- Tracks Medicare ADRs
- Works accounts receivable reports
- Resolve Medicare Secondary Payer issues
- Check on the status of previously submitted claims & resubmit new claims
!!!!!FOLLOW UP…..FOLLOW UP…..FOLLOW UP…..FOLLOW UP…..FOLLOW UP!!!!!
Types of Software Billers May Use
- Billing
- EMR
- Clearinghouse
- DDE
Using Specialized Software
- Purchase Medical billing software programs to create and process bills.
- More efficient
- Less tedious and time consuming
- Be prepared to learn not only the billing component of the software but also all the reports to help you be successful