Medical Billing - DME Software Biller Setup

In this installment of medical billing and the DME software setup, we're going to briefly cover what is involved with the setup that is specifically designated for the people who do the actual billing of claims. This is a very complex process that involves a number of items that all have to work together.

In order to bill an insurance carrier for a claim, there are a number of items that the biller needs access to. This includes the patient personal information, the item being billed, the carrier the bill is sent to and the method by which the bill will be sent. In order for this to happen, these things have to be setup in the system for the biller.

The first order of business is that the biller needs to have patient access. When the bill comes in, the patient number is usually on the first page of the bill. This number should have then been entered into the system along with the patient information. The biller will then have access to this information through what is called a patient lookup feature. These features usually have several fields by which the biller can lookup the patient, such as by last name, ID number, etc.

After the patient is found, the next thing the biller needs to know is what the item is being billed. These items all have to be setup in inventory, which is usually done by the inventory manager. Another lookup function is then provided to the biller for looking up inventory items. This is usually done by item name or sku number. Once the item is found in inventory, the item is then added to the billing sheet.

The next thing that the biller needs is the carrier that is going to be billed and the method by which the bill will be sent. The carrier is usually attached to the patient when the patient file is setup. But in some cases, the insurance carrier is not known at the time and the biller has to add it at the time of billing. For this, another lookup table is provided with all the insurance carriers that the system supports. These are usually updated on a regular basis. The way the biller knows which carrier to pull is by looking at the billing sheet that came in. The carrier is listed there.

The method by which the bill itself will be sent is usually determined by the billing agency itself. Not all agencies have electronic billing capabilities. In the cases where such capability doesn't exist, the default billing method will be via paper claims and the biller won't have to do anything. The claim will automatically go to the print que upon submission.

Naturally, the above process is greatly simplified, but for the most part, that is all that is involved with sending a bill for a medical claim. The truth is, if medical billing was this easy, there wouldn't be so many claims that get denied each day. The problem is that billers are not properly trained and the medical billing software itself can only do so much.

Michael Russell Your Independent guide to Medical Billing