An innovative initiative of the Professional Medical Billers Association (PMBA) USA! We
are a leading platform dedicated to empowering aspiring healthcare professionals with
the knowledge and practical skills needed to excel in the dynamic fields of medical
coding and billing.
Gain experience in the healthcare field : Prior experience in a healthcare setting, such as a medical office or hospital, can be beneficial in understanding the workings of the healthcare system and the role of medical billing.
Pursue education and certifications : Consider taking courses or earning certifications in medical billing, such as the Certified Professional Medical Biller Credential.
Stay up-to-date with industry regulations and changes : The healthcare industry is constantly evolving, so it’s important to stay informed of any changes in insurance policies and government regulations that may affect medical billing.
Develop strong communication and customer service skills : As a medical biller, you will be communicating with healthcare providers, patients, and insurance companies. Good communication and customer service skills can help you resolve billing issues and ensure timely payment.
Build strong attention to detail : Medical billers need to be accurate and detail-oriented in their work, as even small errors can lead to delays in payment or denials.
Invest in the right technology and tools : Prior experience in a healthcare setting, such as a medical office or hospital, can be beneficial in understanding the workings of the healthcare system and the role of medical billing.
Network and seek mentorship : Building relationships with others in the industry, seeking mentorship, and attending industry events can help you stay informed, learn new skills, and advance your career.
Submit claims in a timely manner : Submit claims within the insurance company’s required timeframe to avoid delays in payment.
Follow up on denied claims : If a claim is denied, follow up with the insurance company to understand the reason and to appeal if necessary.
Keep up with changes in insurance policies : Insurance policies and reimbursement rules change frequently, so it’s important to stay up-to-date with the latest changes to ensure accurate billing.
Manage patient balances : Work with patients to manage any outstanding balances, providing them with payment options and financial assistance if necessary.
Invest in medical billing software : Consider investing in medical billing software to streamline the billing process, reduce errors, and increase efficiency.
Accurately identify the type of diabetes : There are several types of diabetes and it is important to identify the type correctly when coding.
Use specific diagnosis codes : Use specific diagnosis codes such as ICD-10 codes to indicate the type and severity of diabetes.
Bill for related complications : Bill for any complications that arise as a result of diabetes such as retinopathy, neuropathy, and nephropathy.
Document all services provided : Proper documentation is key in medical billing, make sure all services provided to the patient are documented accurately.
Use the appropriate CPT codes : Use the correct CPT codes to bill for any procedures performed, such as foot exams, blood glucose monitoring, and insulin injections.
Bill for preventive care : Don’t forget to bill for preventive care services, such as diabetes self-management training and medical nutrition therapy.
Stay up-to-date with coding changes : Keep up with any changes in coding and reimbursement policies to ensure accurate billing.
Incorrect coding : Using the wrong codes, or codes that don’t accurately reflect the services provided, can result in denied claims or lower reimbursement.
Incomplete or inaccurate patient information : Ensure that patient information, such as name, date of birth, and insurance information, is correct and complete.
Late submission of claims : Claims must be submitted within a certain timeframe to ensure payment. Late submissions can result in denied claims.
Lack of proper documentation : Proper documentation is critical in medical billing. Make sure all services provided to the patient are accurately documented.
Upcoding : Upcoding refers to billing for a more complex or higher-priced service than was actually provided. This is considered fraud and can result in significant fines and legal penalties.
Not checking insurance network status : Verify that the patient’s insurance is active and that you are in-network with the insurance company before rendering services.
Not following up on denied claims : If a claim is denied, it’s important to follow up with the insurance company to understand the reason and to appeal if necessary.
Not keeping up with changes in insurance policies : Insurance policies and reimbursement rules change frequently, so it’s important to stay up-to-date with the latest changes to ensure accurate billing.
Not managing patient balances : Failure to manage patient balances can result in decreased revenue and negatively impact the financial stability of your practice.
The Professional Medical Billers Association has achieved Full Accreditation by meeting all of the IAO's Requirements.