Behind the Scenes With a Medical Billing and Coding Expert

If you are like most nurse practitioners, like it or not, you deal with medical billing and coding on a daily basis. You jump through insurance companies’ hoops to get MRIs approved and make a case for the medical need of new, branded drugs. We begrudgingly fill out the necessary paperwork to get our patients the treatments they need, wishing there was a better way. Sometimes, getting a behind the scenes look into a problem can help us approach it more efficiently. So, today, we sent ThriveAP intern and aspiring healthcare administrator Stephanie Bauer out on the town to get a personal perspective from biller and coder Liz Lentil. Here’s what Liz had to tell Stephanie about the complex world of medical billing and coding.

Tell me about your job. What kinds of practices do you bill for? What kinds of insurance claims do you most commonly process?

I work as an accounts receivable and billing manager for an MRI facility where I am in charge of making sure my company gets paid for the CT and MRI scans we perform. I have experience billing all insurance types including commercial, auto, and workers comp companies. Most commonly I deal with your standard commercial insurance plans such as those offered through carriers like Blue Cross, Aetna, United Health Care, and Medicare.

What information is most important for providers to include on a patient’s chart and in their orders to help the coding and billing process to occur in the most accurate and efficient manner possible?

A referring provider must include a diagnosis on any order. It is also beneficial to mention any symptoms that justify the test being ordered, even if this information is not specifically requested. This is especially important as it helps an insurance claim be processed and paid when a ‘rule out’ diagnosis is made. The coding process is carried to completion once the radiologist interprets the actual CT or MRI scan as this often reveals a diagnosis in itself.

What are the most common mistakes you see medical providers make when it comes to coding their charts? How does this affect the billing process?

Medical providers need to be up to date on insurance company policies and services they are billing. If the guidelines are not followed, there certain aspects of patient care will be denied. Not knowing an insurance company’s processes when it comes to ordering costly tests wastes time and can cost a patient and/or facility a lot of money. For instance, a Medicare will not pay for a patient to have a brain scan due to a simple diagnosis of ‘headache’. The scan will be deemed as ‘not medically necessary’ and denied. Listing symptoms that lead to the conclusion the scan was medically necessary, and a diagnosis if identified on the scan, will result in reimbursement from Medicare.

Is there anything you wish providers would let patients know about the billing and coding process during the actual patient visit?

Patients need to be aware of the ins and outs of their own policy. They should know what it does cover, what it doesn’t cover, and more importantly at what location(s) a particular service is covered. Not knowing these things could be the difference between owing a facility a copay or being responsible for any remaining deductible which in some cases can mean thousands of dollars. Providers should explain this to patients when ordering imaging and other expensive tests so their patients can get informed.

Most medical providers are switching to Electronic Medical Records as the preferred form of charting. Have you seen this affect the way providers are reimbursed? If so, how?

We have had an EMR system for several years at my imaging center. I would say the fact that finished reports are all located in each individual person’s chart and are sorted there automatically once they are dictated by the radiologist allows billing to happen more efficiently than with paper charts.

If there was one thing medical providers could do to make your job easier as a biller and coder, what would it be?

Use of updated software would be my pick! The less current a medical practice it is when it comes to technology, the more labor it takes to bill correctly. However, updated software and maintenance packages are not cheap. This is coupled with the fact that insurance companies keep dropping reimbursement rates for services.  Keeping up to date with technology can be especially difficult for small practices.

Thank you to Liz Lentil for her insight into the life of a medical biller and coder and to how we can keep our practices running smoothly!

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