How medical billing works?

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Presenter: Neal
Guest: Karen Moulder
Guest Bio: Karen Moulder was the first woman to be hired in the Brownsville, Texas Fire Department in 1983. Her tomboyish nature and single mother circumstance led her to this fascinating and dangerous career which lasted a little over ten years. Her career involved protecting lives, property, and educating the public on fire safety. She entered a man’s world back when few women did and became a role model for other women. Karen went back to college and majored in business after a car accident ended her firefighting career. She went on to work managing a physician’s office where she obtained her certification in medical billing. She later moved across the country from Texas to Massachusetts where she started her own medical billing company. She now lives there with her five children and two grandchildren. Her Book is entitled “Burning Barriers”

Segment Overview

Karen Moulder talks about the process of medical billing and offers advice to doctors and other healthcare pros on how to handle the stress of billing costs.


Transcription

Health Professional Radio

Neal Howard: Hello you’re listening to Health Professional Radio. I’m your host Neal Howard. We’re in studio today with Karen Moulder. She’s returning to speak with us about her role as a medical billing expert. She was the first woman to be hired as a firefighter in the Brownsville Texas, that happened for her back in 1983. But she has since transitioned into the medical profession on a totally different level, providing medical billing services. How are you doing today Karen?

Karen Moulder: I’m great, thank you.

N: Medical billing, it affects everyone. We get our bills in the mail. Our insurance company pay our physicians or is determined that someone else maybe Medicaid, Medicare or the Veterans Administration. Who knows who’s gonna be paying, but someone is going to get a bill. That’s where you come in, am I correct?

K: Yes.

N: You have your own business. What is the name of your own business?

K: It’s Claim Check Billing Service.

N: Claim Check Billing Service. And you do medical billing exclusively?

K: Yes.

N: When it comes to medical billing, things change rapidly just like gas prices I would assume. How do you keep abreast of all the changes that I’m sure affects you on a daily basis?

K: It’s basically just following the guidelines and the changes that are out. It’s a lot of reading, a lot of studying and keeping up with everything. So that you can be on top of it because you’re right, it is changing. Probably not as fast as gas prices that it does change within 6 months a year, things do change.

N: If someone wanted to become medical billing specialist such as yourself, what are some of the requirements that a person would have to deal with before actually joining your profession?

K: Well because it is dealing with billing and money and finances, you would need to have some kind of accounting background or math skills, good reasoning, good comprehension, trying to think what else, probably good letter writing skills and you would have to have a course on medical terminology – the medical coding. You’d have to know how to coding for that, so it’s a lot to learn.

K: So are there specialized courses?

K: Yeah, there’s a lot of the secondary colleges like if you want to go back and train, they do offer courses in medical billing. The only thing I would recommend is to make sure you know do your homework on which school provides the best courses.

N: Uh huh. When we we’re talking before about your life as a firefighter, you said that you were young and you didn’t realize how much was involved above and beyond fighting fires. In this new career, in this new lifestyle that you’ve chosen in medical billing, were there any surprises or were you thought everything that there was, that you needed to know going through the learning process to become a medical biller?

K: Not really any surprises, it’s just the amount of information that you have to learn in order to do this job. It’s just sometimes can be overwhelming. So that’s one of the things that you have to be able to handle because like I said, it’s changing and you’re always happen to be learning new things. So it’s just keeping on top of it, I would say that it’s the biggest thing.

N: Now as a medical biller, do you have a specialized license or certificate or permit for doing medical billing?

K: Yes, I’m a certified medical coder.

N: Okay, so are there medical coders who are not certified? And can you even legally do medical billing without a certification?

K: Yes, you can be hired without certification. It’s not a requirement, although if I was a physician I would make sure I would hire somebody with a certification because they should know what they’re doing. But to maintain your certification, you have to get CPU’s every year. So basically you have to do your training in order to maintain your certification.

N: Now for our listeners who aren’t healthcare professionals or who are maybe healthcare professionals but aren’t as familiar with how medical billing actually works, could you take us through a typical process for say, one diagnosis to the physician being properly paid?

K: Well, let’s say the patient comes into the office, they see the doctor, basically it’s just one-on-one talking to the doctor. That would be an office visit which putting it into code would be like a 99213. That would be a typical code for an office visit. That is put on a claim with the diagnosis code which would be let’s say pain in foot: 729.5 that’s on top of my head. I would have to use my 99213 with the 729.5 and then bill it at a specific price to the insurance company. They receive it and if that code and they do look at the diagnosis especially when it becomes it’s like procedure related like this sort having any kind of incisions or stuff like that. They do look at those codes to see if they match and if they match and everything is fine and the insurance is good then they send out a payment to the doctor.

N: Okay.

Both: Now…

K: It goes over.

N: Uh huh.

K: And something’s not right, then they send me something back saying “This is not right because of this,” then I have to follow it up and figure out what’s wrong. So that’s where your reasoning skills come in, is like okay what happen? What went wrong? You kind of be detective after that.

N: I’m going to assume that you didn’t wake up and say “You know what, medical billing is what I’m going to do.” When you were becoming a firefighter you decided to do that because well you needed a job, you’re a single mother and well survival comes in many forms. Now that you’re doing medical billing even though you were managing a medical practice in Texas and then you managed on a larger level in a hospital, was there anything that you brought from firefighting that helps you in medical billing?

K: That’s a good question… I honestly don’t know other than…

N: Well you talk about your reasoning skills, your mathematical skills, your ability to see the end of a task I guess at the beginning and see how to work through that. I mean because with the Affordable Care Act, I’m sure your mail box is full of letters saying “Hey this is wrong or change this or research this.” I’m sure that’s more than half of your job.

K: Yes, I know. I mean I was looking at my work today and I was like “Oh I still have a lot to follow up on.” So yeah sometimes it can get overwhelming and you’re right, all of the skills that I had previously, sometimes it’s just part of who you are if you’re very good at reasoning and problem solving, if you’re good at math. Sometimes that’s just part of who you are, so it kind of leads you I think in the direction of what career works good with you. So apparently this was a good fit for me in and I just happened to fallen into it and I really enjoyed doing it.

N: I heard you mentioned that there are physicians who are deciding rather than deal with the sweeping changes known as The Affordable Care Act, they’re just leaving the profession going into something else or going to something that does not involved so much of the regulation. What would you say to your fellow healthcare providers when it comes to dealing with medical billing and the frustration kicks in? What would you say to them in order to encourage them to stick with it as it were because we need you guys?

K: Well this is something that I’ve long thought over about physicians. Once a physician goes to school they go to school to learn medicine, they don’t go to school for business and running a business. And what most people don’t understand that they are physicians but they are also running a business. Where they have to hire an employees and they have to you know it’s a business and a lot of people don’t look at it that way, they just say “Oh he’s a doctor you know or she’s a doctor.” But they have to run a business and most physicians do not get business training on how to run a business. So it’s so important for them to get that second person in charge, a manager or somebody who knows what they’re doing to help them run their practice and run it efficiently. If they don’t do that, it doesn’t matter what changes come across or how easy it is, it’s not gonna work.

N: Great. Some great advice from Karen Moulder in studio today talking with us about some of the ups and downs of being a medical billing expert. And she’s also given us some great advice for our healthcare professionals when it comes to dealing with some of the frustration that maybe involved. It’s been great having you here with us today Karen.

K: Thank you.

N: Great. Transcripts of this program are available at hpr.fm and also at healthprofessionalradio.com.au.

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