What Does a Medical Biller (Actually) Do? How to Get Faster Payments

What Does a Medical Biller (Actually) Do? How to Get Faster Payments

Your billing company is a crucial component to your practice's success. Learning and understanding the billing process and what your biller does daily, will help contribute to the everyday operations of your business.


What Does Your Medical Biller (actually) Do?

Your biller's job is to use provider documentation to produce and submit claims to insurance companies. Your biller will then work directly with the insurance companies, healthcare providers, and patients to get claims processed and paid. They also review and appeal unpaid and denied claims. Your billing team will verify patients’ insurance coverage and answer patients’ billing questions. Collections on unpaid accounts are also a big part of the process.

A lot of these duties are dictated by your front desk staff. Therefore, proper front desk training is paramount in your business.


3 Questions that Billers Ask Themselves Daily?

  • Why is the payer not paying? - Billers receive denials daily. It is their job to figure why the claim has not been paid. Top reasons are – modifiers, data entry errors, insurance has not been verified, or an incorrect diagnosis.
  • How can this denial be appealed or reprocessed? - Contacting the Insurance company to appeal or reprocess the denied claim is the first place to start. The biller also needs to be familiar with the billing processes for each of the payers.
  • Did I receive sufficient payment? - Billers should understand and know the payer’s contracts. The contracts state how claims should be billed and reimbursed. Each payment should be reviewed to make sure the correct payment has been received.


Knowing Your Payers

Billers should be very familiar with the important parts of the contracts with each payer. Here are some of the ins and outs that every biller should know:

How long does it take this payer to pay?

This is very important when trying to track the aging of your accounts. If an electronic transfer is offered by the payer, this is the fastest and most efficient way to get paid and get accounts removed from your account receivables.

What’s the payers appeal process?

Knowing this process will help with denials from your payers. Each payer has a specific way they will accept denials within a specific timeframe. Frequently there is a resubmission process that should be completed before the appeals process is even needed. Biller will need to know this information.

Who’s my provider representative?

Getting to know your provider representatives are key to helping you with denials and claims you may have trouble getting paid on.

What type of contract does this payer have?

There are several types of contracts:

Group Contract - this contract pays as a group and not as an individual provider. The upside to this type of contract is helpful for your payments and credentialing.

Provider Contracts – this is a contract payer for each individual provider. This type of contract can be hard for a biller when you have more that 4 or 5 providers as each provider will usually have a different contract and reimbursement.

How much are you getting paid?

Fee schedules are very important to a biller. Your biller will need to access and be very familiar with each payers’ fee schedule. This will tell the biller how much the payer is supposed to pay you for every code available. This information is included in your negotiated contract.

Everyone in your business contributes to what the biller must do on the backend to get your claims paid. Your providers are very important to the process, making sure every service provided is documented and allowing coders to interpret with the proper codes. Your front desk staff are just as important, as they are responsible for gathering all the demographics and insurance information used in the process. Billers can only use what they are given. Time is money so getting the information right at the time of service will help with clean claims and getting your payment faster.

I hope these little nuggets of information help you better understand what you billers are doing on a day to day basis. This snapshot is only a fraction of what they are doing to make sure you are getting paid correctly and efficiently. I don’t recommend you try to do this yourself, instead, hire the right people to make sure the job gets done properly.

Candice Smith-Riles
Sales and Experience Director
Medical Practice Succes