Looking for work as a medical biller

I got an email this weekend from someone asking how to find a job in medical billing now that she has finished school and graduated with honors.  I told her that I would give her the same advice I just gave my grandson who is looking for a new job.

Yes, it’s a tough economy now.  Many businesses are laying off.  But there are a few jobs available.  There are new doctors getting started who need help.  There are people retiring in doctors offices.  There are offices expanding.  There are a few jobs out there.  There may be ten people looking for one job (or even more than ten) but one person will be hired for the job.  Make sure you present yourself as that person.  Be the person that doctor or hospital wants to hire.  Get your resumes’ out there.  Call the employers and check to make sure they got the resume and ask if they will consider you for a job.  Make sure your resume is good.  Get help if you need it.  Call all the billing services in your area and ask if they are hiring.  Keep your ears open to any news from any doctor’s offices about anyone leaving.  Be serious about looking for the job.  Your job while you are looking is to look for a job every day.

It is a tough economy right now. We are all being touched by it. We would much rather be enjoying a healthy, growing economy, but that’s not the reality now.

Filing Secondary and Tertiary Insurance Claims

When we first started our medical billing business in 1994 I had no previous experience at billing any medical claims, let alone secondary and tertiary. (You mean some people have 3 insurances?) I knew nothing. In fourteen years of billing I’ve learned quite a bit and I see from questions in our forum that many beginners do not understand secondary and tertiary claims billing at all.

First of all, how does anyone get two or three policies and which is determined primary? If a husband and a wife both work (who doesn’t?) and they are both covered by health insurance by their employers, they may both have family policies so they are both covered under each others plan. One would be primary and the other secondary. Now if one of this couple (a few years ago we would have assumed that it would only be the husband) had previous military experience and carried over their Tricare military insurance, that would be the third payor (if there was a balance left).

Which company is primary and which one is secondary is determined by one of a couple different methods. First of all, if a person is working and they carry insurance, that insurance is primary (unless they have Medicare and their employer has less than 100 employees). If a person is retired and has Medicare but the spouse works and carries a family policy, then the spouse’s plan would be primary and the Medicare would be secondary.

There is no way to cover every scenario but basically whether or not the person or the spouse is working can determine the order. For dependants (usually children) some go by the “birthday rule” meaning that whichever parents birthday falls first in the year is primary. Of course with all of the divorce out there sometimes the order of insurance is determined by a court order.

When a patient is seen by a provider the claim is sent on a CMS 1500 form to the primary insurance carrier either electronically or on paper. Electronically it can be sent either directly to the insurance carrier by special software or through a service or through a clearing house. When sent on paper it simple means the claim is printed to a paper CMS 1500 form and sent through the mail. Whatever the case is, it is important that you know the order of the policies.

Once the primary insurance carrier pays their share of the claim it is then submitted to the secondary insurance company if the patient has one. Secondary claims can also be sent electronically and on paper. Medicare is mandating electronic submissions even on secondary claims. When submitted electronically all the information from the eob (explanation of benefits) is entered into the claim information and submitted to the secondary insurance carrier.

When the secondary is submitted on paper, the claim is printed out again on a cms form and a photocopy of the eob is attached. If other patients are listed on the eob, their personal information should be hidden. Many offices use black markers (we call them smelly pens) to draw through the unwanted information. I’ve set up a bunch of various width strips of white cardboard that we slide into clear report covers to cover the unwanted information before we photocopy. We only do this with companies that are not yet accepting electronic submissions.

If there is still a balance after the secondary insurance carrier pays their share, the claim is sent on to the third carrier. It is printed out again on a cms form and copies of the eobs of both the primary and the secondary insurance carriers are attached.

Whenever you send secondary and tertiary claims on paper, make sure the photocopies you attach are clear, easy to read, and for the correct date of service. Many insurance carriers scan the eobs which lightens them a little. If the copy you submitted was already light, by the time the claim is processed it may be sent back to you as unreadable. It takes a lot more time to find the original eob and resubmit a claim than it does to get it right the first time.

Secondary and tertiary claims can sometimes seem like a pain to get paid – especially because they can be for a very small amount of money. It is still important to file and track these claims to keep your receivables under control. It may not seem like a lot of money but it adds up. If you have a system for submitting them it really isn’t that bad.

Here are more articles we’ve written about various aspects of medical billing.

Taxonomy Codes – Why They Are Important

What the heck is a taxonomy code and why is it important? Taxonomy Codes are an administrative code set for identifying the provider type and area of specialization for health care providers. They are alphanumeric and are ten characters in length. Taxonomy codes allow providers to identify their specialty. A provider can have more than one taxonomy code.

Taxonomy Codes have 3 distinct levels. Level I is the provider type which is a
major grouping of health care providers. For example: Dentists, Osteopathic Physicians, and Chiropractors.

Level II is Classification or a more specific service or occupation related to the provider type.

Level III is the Area of Specialization. This is a more specialized area of the classification in which a provider chooses to practice or make services available. This is usually based upon the sub-specialty certificate.

Taxonomy Codes allow the provider to identify their specialty at the claim level so this can directly affect your reimbursement from insurance companies. If you have an inaccurate taxonomy code linked to your NPI number then your services may be paid at a lower reimbursement rate, or outright denied by an insurance company.

For Example: If you are a Pediatric Surgeon and you pick a taxonomy code for just straight Pediatrics, your services may be denied. You would need to pick the more specific code of Pediatric Surgeon (at Level III) in order to ensure proper reimbursement for your services.

If you have more than one specialty you can pick more than one taxonomy code. In the NPI system if you have more than one taxonomy code you do have to indicate which one is primary.

Insurance carriers are going to start to request (then require) that you have the taxonomy code on claims when they are submitted. They are going to be in box 33b on the CMS 1500 form. If a provider has more than one specialty it will be important that they put the appropriate taxonomy code for the service they are billing for on the claim.

For Example: I have a provider who is a DO and does osteopathic manipulation. He is also certified for treating drug addiction. This may seem like a strange combination, but it is actually genius. People who are addicted to Oxycodone were prescribed the drug due to pain. Now they are addicted and need to be treated for the addiction, but many still have the pain. He can treat their drug addiction, and also relieve their pain with osteopathic manipulation.

Ok, I got a little off track. The point is, if he is billing for services that are treating the drug addiction, then he should have the taxonomy code for the addiction medicine on the claim. If he is billing for the osteopathic services, then the taxonomy code for osteopathic medicine should be on the claim.

Picking the correct taxonomy code is extremely important because it can directly affect your reimbursement by insurance companies. If you are not sure the correct taxonomy code is on file with NPPES (NPI system) then you should double check it. Better safe than sorry.

Here is a link to a web site that has a listing of taxonomy codes.

Free Medical Billing Newsletter Topics

We’re getting ready to release the January issue of our free monthly medical billing newsletter and here are the topics we are covering this month.

Billing at the Workers Comp Fee Schedule
Medical Billing as a Career
Filing Secondary and Tertiary Claims
What Are Taxonomy Codes and Why Are They Important

You will also find our forum question of the month and a helpful website listing the names and addresses of many many insurance companies. (I hate to say all insurance companies because they may have missed some, but it’s a great resource.)

You can sign up for our free monthly newsletter at Medical Billing Live.

You can also find many articles on medical billing on our informational website at Solutions Medical Billing.


Do you have a medical billing question?

How many times a day do each of us come up with a question in the field of medical billing? Quite often. It seems like there are more questions than there are answers. With so many variables we run into many different situations that require different actions every day of the week. It’s nice to be able to share answers. Like this morning. It wasn’t a medical billing question, but we needed an answer.

Six AM I got a call from Michele. Her husband Rick was late for work because one of the cables on their garage door had snapped with both cars trapped in the garage. How do you get the darned door open with only one cable. If there was a garage door forum, we would go to it and ask our question which we probably would find was already answered many times by grateful people who hadn’t been killed when their cable snapped. I did suggest that Michele “google” the problem. Not sure what happened as my husband hasn’t returned yet from trying to help them.

My point?? You can get answers to your medical billing questions on our free forum.

Now does anyone know of a garage door forum?


Medical Billing As A Career

Many people are looking for new careers in this wild economic period. As jobs are cut workers are forced to look at new opportunities and many are turning to the medical field. It makes sense. As our population ages, especially us baby boomers, the medical field only grows. What are the options in choosing medical billing as a career?

Anyone who understands the field of medical billing can find several different opportunities for work. Many physicians hire medical billers to take care of their insurance billing. Hospitals have large billing departments and are often looking for billers. Many medical billing services like ours look for experienced medical billers. We know of many people who work from home and bill for a social worker or two for a little extra money.

Then there is always the option of starting your own medical billing business. A medical billing service can be run from home. You don’t necessarily have to go out and rent office space. This can be a great choice for a mother who wants to stay home with her children.

So if you are interested in a position as a medical biller, decide on the type of situation that would best fit your needs. Do you like working in a large busy office with lots happening like a hospital, or do you prefer a small intimate setting. Some people love to work with others and some people prefer to be left alone to get their job done. If you are considering this field, there is lots of opportunity. As our population ages, more and more people are going to the doctor more often. Here is more information on starting your own medical billing business.


PS 6 more inches of snow last night. Two more hours of snowblowing today. And more predicted tonight.

Medicare Carriers switching can be frustrating

Well it’s been over 4 months since our Medicare switched carriers and they still haven’t smoothed out all the bumps yet. It has been a very frustrating transition for us. I’ve seen a lot of contracts switch carriers, but I’m thinking this is the worst I’ve witnessed. We have had nothing but problems since NGS took over Upstate Medicare in NY. I’m actually going to take the time this weekend to write up a complaint to give to Congressman Michael Arcuri. The previous carrier had the contract for many years, and they did an awesome job. You always knew what to expect from Medicare and could always get a straight answer when you called. Now you get the strangest denials, and even stranger explanations when you call. Enough is enough, it’s time to do something about this!

Anyone else having the same problems?

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To visit our forum to view questions, post questions, or answer questions on medical billing visit Medical Billing Live

Par Vs Non Par – What’s best

When I first started in this field I thought that providers were crazy not to Par. Patients don’t want to go to providers that don’t participate with their insurance carrier. It just seemed like if you wanted to make money, you needed to be in network.

Now things are a little different. Some insurance carriers actually pay MORE to out of network providers. That seems crazy to actually reward the out of network providers.

So now if providers ask me whether or not they should be in network with the insurance carriers, I tell them it depends on which one!

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To visit our forum to view questions, post questions, or answer questions on medical billing visit Medical Billing Live

Chiropractors will be happy

We got some good news for our chiropractor clients from our local Blue Cross. They are going to start paying at the Medicare rate instead of the global $30 fee they have paid for years. The Medicare rate is a little better than the $30 per visit Blue Cross has been paying. Blue Cross is a major carrier in our area so this should make a little difference for a specialty that has taken some hits in the last few years.


New Year – Deductibles, New Insurances, New Headaches

Well, it’s 2009. For medical billers this has an added meaning other than new starts, new resolutions, losing weight (lol), etc. It means remembering to key in 2008 for the December charges that we’re still entering and 2009 for the January ones. May sound stupid to some, but to those who work with software programs that make this not so easy, they completely understand.

It also means deductibles kick in. (You mean I have to pay my deductible again? I just paid it in January of last year.) It also means patients may have a new insurance plan and forget to tell the doctors’ office. Many employers switch insurance plans on the start of the new year.

New fee schedules for Medicare and other carriers.

New rules regarding authorizations.

There are a lot of news for us medical billers when it comes to a new year. So lets get started on another year of fun! 🙂

To receive our free monthly newsletter visit Solutions Medical Billing and enter your email address.

To visit our forum to view questions, post questions, or answer questions on medical billing visit Medical Billing Live