Medical Billing For Nurse Practitioners – Get The Best, For Less
Are you wondering about medical billing for nurse practitioners? Read this guide to learn everything you need to know.
As a nurse practitioner, you may need to handle billing from time to time. If that’s the case, there are all sorts of things you’ll need to know.
With so many things to learn, how do you know where to start? You may wonder what medical billing is and why it’s important. And you’ll need to know how to do it the right way.
To help you get on your feet, we’ve created this helpful guide. Keep reading to learn the basics of medical billing for nurse practitioners.
What is Medical Billing?
Medical billing is the process of contacting insurance providers to ensure a medical practice receives payment for services rendered. If no one creates claims and sends them to insurance providers, the medical office won’t receive reimbursement.
Medical billing may be confused with medical coding, but they’re completely different things. A medical coder assigns standardized codes to medical statements while a medical billing specialist follows up with claims and ensures they’re taken care of properly.
Billing and coding are both important and they may even be performed by the same person (potentially yourself), but they aren’t the same thing.
If a medical office doesn’t have someone designated to handle medical billing, it may be outsourced to another company.
The Importance of Medical Billing
Medical billings ensure that medical services are properly paid for. Since there are so many types of medical services, there’s no single bill that’s sent out to insurance providers. There has to be some designation of what services occurred, what the cost was, who it was for, etc.
Medical billing takes care of these issues. Essentially, a medical biller makes sure money comes in at the right amount and for the right services.
Different medical procedures have different costs. Nobody wants to get hit with a $5000 bill for a service that should have cost $50. Medical billers help make sure everything is billed and paid for properly.
What Does a Medical Biller Do?
If you’re asked to help with or take over the medical building for the practice you work for, you’ll have a few tasks to perform. You’ll need to assemble all important data for each bill.
Good communication is important in medical billing. Why? Because you’ll need to work with several people on a regular basis.
You’ll experience regularly communication with the healthcare professionals you’re handling billing for. They’ll help you square away anything that isn’t clear, such as diagnoses or any missing information.
While a medical biller is not the same as a medical coder, he or she will need to understand what the codes mean. Otherwise, he or she won’t be able to bill for services properly.
Types of Medical Codes
There are several types of codes you’ll likely encounter when billing for medical services. These include the following:
Common Procedural Codes (CPT)
The codes use both numbers and letters and contain five characters per code.
Healthcare Common Procedure Coding System (HCPCS)
These include three levels of codes. Level I codes are made up entirely of numbers. Level II and Level III codes include numbers and letters, with Level III codes being used as local or miscellaneous codes.
Despite there already being three levels of codes within the HCPCS system, these codes may still require the use of modifiers. These modifiers show up as two extra characters (letters or alphanumerical characters) and give additional information regarding the service performed.
International Statistical Classification of Diseases (ICD)
These codes offer standard designations that are the same across the world. No matter who uses these codes or how they’ll always have the same meaning.
Diagnostic Related Grouping (DRG)
These codes relate to diagnoses. They’re only used for inpatient claims.
Other Coding Systems
The codes mentioned above are only some of the commonly-used coding systems. You may need to become familiar with other systems as well.
Medical Billing Training
If you’ll be handling the medical billing for your practice, or even helping out at times, it’s important to get the proper training. Billing for a service incorrectly means you won’t be reimbursed correctly. If that happens, a patient or insurance provider may be asked for too much or too little money.
Since you’ve already completed certain requirements to become a nurse practitioner, you won’t need to worry about some requirements. For example, you won’t need to worry about getting an Associate’s Degree at this point in your career.
You may want to consider becoming certified in medical billing, though. While it isn’t required to get the job done, it will show any other professionals you work with that you know what you’re doing. And you’ll be more certain that you’re doing the job correctly, thanks to your special training.
Medical Billing Certification Programs
The American Academy of Professional Coders (AAPC) offers certifications for both coding and billing. Their billing certification includes basic coding education but focuses on billing as a provider. This certification only takes a few months to complete.
A familiarity with physiology, medical terminology, and anatomy is suggested by the AAPC. But since you’ve already become a nurse practitioner, you probably have those things under your belt already.
The American Medical Billing Association (AMBA) also offers a billing certification course. You’ll have to join the AMBA to take their certification exam, though.
Both of these certifications are nationally recognized.
Medical Billing for Nurse Practitioners
Nurse practitioners can be busy, but don’t let that stop you from making sure medical billing is properly carried out. If you don’t have someone specifically employed for that purpose, you can do it yourself.
Luckily, medical billing isn’t overly complicated. Once you take the time to learn the code systems and understand procedures, you’ll be able to do it yourself, whether you’re certified or not.
If you don’t have the time or resources to do it yourself, consider hiring a medical billing professional. Check out our list of the best medical billing service companies of 2018.
Author: Mike Cynar
Mike Cynar brings buyers and sellers together by producing reviews and creating non biased webpages allowing users to share their experiences on various products and services. He and his staff write informative articles related to the medical field, legal, and other small business industries.