Sample Paper on Professional Medical Interview

Professional Medical Interview

I had an opportunity to interview one of the professional medical insurance claims processors last week. I was able to get Ms. Lau Jansen, of the McLaren Medical Foundation based in Detroit. I must admit that the process of getting an interview appointment and booking was not easy but I remained persistent and finally secured the time slot. The interview entailed several questions that prompted an in-depth discussion on various issues affecting the medical billing industry. I focused on three major issues including: the roles and characteristics of medical claims processors, the medical billing process and the use of technology in the medical billing process.

To begin with, Ms. Jansen elaborated during the discussion that medical insurance claims processors are people who deal with checking of received claims from clients. The processor verifies that the information provided by patients are very accurate and in the event that there are any unclear facts, she contacts the patient, a physician or the medical facility to pick up the missing data. She mentioned that for one to be a successful medical claims processors, he or she  must be knowledgeable on the terms used in this medical field like the Current Procedural Terminology (CPT), the appropriate codes and the International Classification of Diseases, or ICD to enable them survey the claims successfully.

Filling Medicare

Regarding the Medicare procedure, she mentioned that most medical services suppliers prepare their insurance claims by utilizing the data given in the patient’s bill. Once in a while they prepare this manually and then send via email but almost all of this is done and submitted electronically. This is preferred because it is the most efficient and effective method to process the claims that enables organizations to save costs in comparison to the paper entries. I established that one of the purposes behind the switchover from ICD-9-CM to ICD-10 is due to the flexible nature of the latter code to electronic utilization. Submitting claims electronically lessens the measure of manual information the medical biller must perform. With insignificant simple collaboration, electronic entries minimize mistakes that can be made and provide back up plans according to (Walker, Deborah, Larch and Woodcock).

The medical billing cycle/process

Ms. Launsen mentioned that the medical billing process is not undertaken by a single person in the organization. Instead, it involves the successful collaboration of others like the receptionists, office administrators, the back office staff members inclusive of the medical biller and the coding officer. The first step of the medical billing process involves a patient making an appointment to see the doctor.  The workplace’s front office staffs, normally a secretary, handles preregistration and calls the patient to make an arrangement. During this time, data must be gathered by the front office to get ready for the patient visit. This incorporates essential data on the patient, for example, name, location, date of birth, and the purpose behind visit. The front office also gets insurance data from the patient, including the name of the insurance supplier, and the patient’s strategy number.

Setting up and redesigning medical documents for the patient facilitates the billing process and makes patient registration less demanding and more effective. It additionally takes out potential mistakes and enrolment hiccups, for example, the patient neglecting to bring insurance data on the day of the appointment.

Once this information has been collected, the physician’s office determines who will be paying for the medical organizations that will be given in the course of action. Utilizing the insurance data as provided by the patient, including their insurance arrangement number, the workplace must affirm which administrations are secured under the insurance approach and what medical conditions the insurance supplier requires with a specific end goal to legitimize instalment for those administrations. The billing procedure ought to be disclosed to the patient. This implies that the patient ought to be educated of administration fees not secured by their insurance cover and the out-of-pocket expenses. It is imperative for the doctor to record every single medical administration so the workplace can make a precise hospital expense to send to insurance suppliers or patients.

It is the role of the medical insurance billing officer to determine the medical strategies performed amid the patient’s visit into a progression of medical code set of the social insurance industry. These codes streamline the recording of medical administrations. After the medical coder has decided the patient’s treatments and coded these utilizing the ICD and CPT, the doctor’s visit expenses are compiled. In the record, the medical biller figures the patient’s offset by including any past and new charges, subtracting instalments made (either by the insurance agency or the patient). This data is given to the patient as a receipt. The patient can then look at.

Prior to a bill being recorded and sent off to the payer, it should first fulfil certain official prerequisites. These prerequisites contrast in the middle of coding and billing systems, and in addition insurance suppliers and sorts of medical administrations provided.  Worth noting is that the process of billing must be in line with the prerequisites set by the Health Insurance Portability and Accountability Act (HIPAA), and the Office of Inspector General (OIG). The medical biller must affirm that every charge is identified with a particular technique code (Schiff). Distinctive medical offices have diverse charges and expenses for their administration, so charges must match the standard set by the particular medical practice. Diverse practices as a rule have their typical charges recorded in a standard expense plan. The medical biller should affirm that each code is billable. It is essential for the medical biller to be consistent with the payer’s guidelines. In the event that a bill is conveyed to a payer that incorporates charges outside of these tenets, the bill may be denied and came back to the doctor’s office for revision.

When all judgments and medical methodology have been recorded, coded, and checked for agreeability, the bill is prepared to be conveyed to the insurance agency, or payer. This insurance claim furnishes the payer with critical data about the determination, systems, and the charges collected by the patient (Gater). At the point when a payer gets an insurance claim from a clearinghouse it is looked into through a procedure called settling. Amid arbitration, the insurance supplier puts the claim through various distinctive steps, considering different elements, keeping in mind the end goal to assess the bill. Here, the insurance supplier figures out if they will pay the whole charge, a part of the bill, or in the event that they will deny the bill altogether.

After the claim experiences mediation, the choice to pay all, some, or none of the bill is sent back to the social insurance supplier as a report. Another real stride for the medical biller is to affirm that the charges and expenses matchup between medical practice and insurance agency (Merlin). It is uncommon that expenses for both sides match up impeccably. Once more, the sum repaid to the human services supplier is in light of the assertion they have with the individual insurance agency. In the event that the methodology and codes recorded in the insurance supplier’s exchange report coordinate those sent by the medical services supplier and consistent with the budgetary understanding between the both sides, they are included in the patient’s record.

At the point when a patient is sent a bill with the remaining balance for the medical services provided, an instalment date is situated and recorded on the bill itself. From patient registration to last bill accumulation, the procedure of data assembling, recording, and transmission requests proficient consistency. Ms. Jansen mentioned to me that the recent development in technology has greatly improved the medical billing process. This is in line with the observations of (Burgos, Marilyn, Johnson, and Keogh) who took note that the current innovation has streamlined the procedure, taking into account convenient transmission of data and effective correspondence between all gatherings.


Works Cited

Burgos, Marilyn, Donya Johnson, and James E. Keogh. Medical Billing and Coding Demystified. , 2007. Internet resource.

Coslick, Merlin B. Medical Billing: Home-based Business: Success in Marketing and Consulting. Watchung, N.J: Electronic Medical Billing Network of America, 1998. Print.

Gater, Laura. How to Open & Operate a Financially Successful Medical Billing Service: With Companion CD-ROM. Ocala, Fla: Atlantic Pub. Group, 2010. Print.

Schiff, Merry. Medical Billing Handbook. Upper Saddle River, N.J: Pearson/Prentice Hall, 2005. Print.

Walker, Deborah L, Sara M. Larch, and Elizabeth W. Woodcock. The Physician Billing Process: Avoiding Potholes in the Road to Getting Paid. Englewood, CO: Medical Group Management Association, 2004. Print.