# Ask the Medical Billing Specialist **URL:** \ **Category:** Miscellaneous and Personal Stuff I Must Share\ **Created:** [February 1, 2005, 11:58pm UTC](https://boards.straightdope.com/t/ask-the-medical-billing-specialist/287880 "2005-02-01T23:58:32Z")\ **Posts on this page:** 9\ **Page:** 2
**Author:** ![LavenderBlue](https://avatars.discourse-cdn.com/v4/letter/l/e95f7d/32.png) [@LavenderBlue](https://boards.straightdope.com/u/LavenderBlue)\ **Post date:** [February 3, 2005, 7:42am UTC](https://boards.straightdope.com/t/ask-the-medical-billing-specialist/287880/21 "2005-02-03T07:42:03Z")
> [@MsRobyn](#): > > Former radiology coding/billing specialist here. > > In my experience, it is no longer possible to do this at home. Thanks to HIPAA, there has been a huge crackdown on the confidentiality of patient health information. My practices basically adopted a policy that nothing with patient information was to leave the office. Much of this can be done electronically, but few, if any, practices are willing to invest the kind of money it takes to ensure that information is securely transmitted. > > As to pay, it depends on who you work for and where you live. Large practices and hospitals tend to pay more and have better benefits than smaller practices. I’ve made anywhere from roughly $10 to $15 an hour. > > In terms of education and training, it’s better to go through a community or technical college. This ensures you will be able to take certification exams, which may be required by some employers, and it gives you a leg up on people who don’t have formal training. Since most colleges have job placement offices, it’s easier to get job leads, as well. The other benefit to community college is that you may be eligible for financial aid or job training assistance. To be honest, those home-study courses that advertise on TV are a waste of money. I’ve never known anyone who took that course who actually got hired. > > Robin Thanks for the info. FTR I was just curious but not personally interested. I actually have a nice little work at home job that pays reasonably well. ---
**Author:** ![Sassafras](https://avatars.discourse-cdn.com/v4/letter/s/a87d85/32.png) [@Sassafras](https://boards.straightdope.com/u/Sassafras)\ **Post date:** [February 3, 2005, 1:34pm UTC](https://boards.straightdope.com/t/ask-the-medical-billing-specialist/287880/22 "2005-02-03T13:34:16Z")
Biller here for an ob-Gyn group Just wondering how many of you billers play this game with insurance companies File the claim- call to ck status- insurance company says they don’t have it . File again, call to ck status, they say they don’t have it . File again etc etc. One fine day call to ck status- they now have the claim, but OH NO. Now its past the filing limit. Have to appeal the claim. Our computer tracks claims, and they are sent electronically so at least we have proof of timely filing. I deal with one particular insurance company that this ALWAYS happens with- but only on claims that are over $1500.00. Hmmmm. :rolleyes: ---
**Author:** ![ms\_mom67](https://avatars.discourse-cdn.com/v4/letter/m/bc79bd/32.png) [@ms\_mom67](https://boards.straightdope.com/u/ms_mom67)\ **Post date:** [February 3, 2005, 1:39pm UTC](https://boards.straightdope.com/t/ask-the-medical-billing-specialist/287880/23 "2005-02-03T13:39:08Z")
I am taking a course at the local college for medical billing and coding.I never realized what went into it. Right now I am taking the Basic ICD-9-CM. I am trying really hard but I’ll tell you it’s a lot to learn, in a class room. I have 4 weeks left in this term and I am thinking what in the world have I gotten myself into. All I can say is it’s pratice, pratice, practice. By the time I am done with class I have a major headache. I hate mondays… :smack: ---
**Author:** ![Unintentionally\_Blank](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/unintentionally_blank/32/5418_2.png) [@Unintentionally\_Blank](https://boards.straightdope.com/u/Unintentionally_Blank)\ **Post date:** [February 3, 2005, 3:10pm UTC](https://boards.straightdope.com/t/ask-the-medical-billing-specialist/287880/24 "2005-02-03T15:10:34Z")
Do you know a rough percentage difference between what the hospital bills and the insurance company negotiates? It seems to really blur the lines of what service is being provided. My sons were 5 weeks premature, and the rule of thumb was that it cost _someone_ $5000 a day, per kid - (actually, 5 weeks for one, 2 weeks for the other or a cool $245,000) We never saw that bill. Just reciently, one son spend three days in for rehydration with a virus - billed amount $7500 - calculated negotiated amount - $6500, our out of pocket - $1500. Makes things very confusing when a serving of motrin is $2 + $20 hospital fee + $20 admin fee + ??? insurances - ??? negotiated reduction. ---
**Author:** ![Indyellen](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/indyellen/32/4176_2.png) [@Indyellen](https://boards.straightdope.com/u/Indyellen)\ **Post date:** [February 3, 2005, 5:27pm UTC](https://boards.straightdope.com/t/ask-the-medical-billing-specialist/287880/25 "2005-02-03T17:27:57Z")
> [@Sassafras](#): > > Biller here for an ob-Gyn group > > Just wondering how many of you billers play this game with insurance companies > > File the claim- call to ck status- insurance company says they don’t have it . File again, call to ck status, they say they don’t have it . File again etc etc. One fine day call to ck status- they now have the claim, but OH NO. Now its past the filing limit. Have to appeal the claim. Our computer tracks claims, and they are sent electronically so at least we have proof of timely filing. I deal with one particular insurance company that this ALWAYS happens with- but only on claims that are over $1500.00. Hmmmm. :rolleyes: Can you say “delay in payment”? I knew you could. 🙂 Yeah, we do that too. I send print screens & copies of our electronic filing batch all the time. Have you turned them in to the Department of Insurance for it yet? It’s _very_ illegal in most states to delay payment that way. You might try talking to your Provider Relations person, too. They’ll _swear_ they never do that, but usually you can scare them pretty well by mentioning the Department of Insurance (unless they’re self-funded - I _hate_ ERISA.) I have some guesses as to which company it is, too. 😉 ---
**Author:** ![Indyellen](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/indyellen/32/4176_2.png) [@Indyellen](https://boards.straightdope.com/u/Indyellen)\ **Post date:** [February 3, 2005, 5:33pm UTC](https://boards.straightdope.com/t/ask-the-medical-billing-specialist/287880/26 "2005-02-03T17:33:11Z")
> [@ms\_mom67](#): > > I am taking a course at the local college for medical billing and coding.I never realized what went into it. Right now I am taking the Basic ICD-9-CM. I am trying really hard but I’ll tell you it’s a lot to learn, in a class room. I have 4 weeks left in this term and I am thinking what in the world have I gotten myself into. All I can say is it’s pratice, pratice, practice. By the time I am done with class I have a major headache. I hate mondays… :smack: Good luck…it takes getting used to, but once you understand how the book is organized, and know your medical terminology, it’s not TOO bad. Remember, too, that in most cases you’ll end up being given the diagnosis code (or at least a full diagnosis) by the doctor. It’s the _additional_ diagnoses that can get confusing. I’m better with procedure coding than I am ICD-9, but I have more practice at that. I wish you well with your classes! 😃 ---
**Author:** ![Indyellen](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/indyellen/32/4176_2.png) [@Indyellen](https://boards.straightdope.com/u/Indyellen)\ **Post date:** [February 3, 2005, 5:40pm UTC](https://boards.straightdope.com/t/ask-the-medical-billing-specialist/287880/27 "2005-02-03T17:40:58Z")
> [@Unintentionally Blank](#): > > Do you know a rough percentage difference between what the hospital bills and the insurance company negotiates? It seems to really blur the lines of what service is being provided. > > My sons were 5 weeks premature, and the rule of thumb was that it cost _someone_ $5000 a day, per kid - (actually, 5 weeks for one, 2 weeks for the other or a cool $245,000) We never saw that bill. Just reciently, one son spend three days in for rehydration with a virus - billed amount $7500 - calculated negotiated amount - $6500, our out of pocket - $1500. > > Makes things very confusing when a serving of motrin is $2 + $20 hospital fee + $20 admin fee + ??? insurances - ??? negotiated reduction. Well, I know there’s a formula you can use to calculate a fee schedule (at least for a physician practice) based on Medicare allowable costs times a decimal or percentage, with allowances for location and mean local costs…but I don’t know what it is. ☹ Maybe one of my compatriots will. The only example I can think of off the top of my head involves Medicaid, not Medicare, but: To place an ear dranage tube ON ONE SIDE, our fee schedule charges $480. The Indiana Medicaid allowable is $113.80. I know Medicare pays more, I just don’t have the allowables memorized for that. Our commercial insurance contracts range from probably $175-$275 or so (estimates!!!) per side…but the 2nd side only pays at 50% of the allowable in most cases. It’s one of those things. There’s a lot more to it than most people realize. ---
**Author:** ![MsRobyn](https://avatars.discourse-cdn.com/v4/letter/m/90ced4/32.png) [@MsRobyn](https://boards.straightdope.com/u/MsRobyn)\ **Post date:** [February 3, 2005, 7:36pm UTC](https://boards.straightdope.com/t/ask-the-medical-billing-specialist/287880/28 "2005-02-03T19:36:23Z")
> [@ms\_mom67](#): > > I am taking a course at the local college for medical billing and coding.I never realized what went into it. Right now I am taking the Basic ICD-9-CM. I am trying really hard but I’ll tell you it’s a lot to learn, in a class room. I have 4 weeks left in this term and I am thinking what in the world have I gotten myself into. All I can say is it’s pratice, pratice, practice. By the time I am done with class I have a major headache. I hate mondays… :smack: If it helps, you probably won’t have to memorize the whole book. If you do, your instructor is wasting your time. It’s like the phone book – once you remember that pneumonia is in the Respiratory Diseases section and not in the Infectious Diseases section at the beginning, you can always look it up. (And once you remember that the Infections Diseases section is largely systemic and not disease confined to a particular system, you’re in like Flynn.) And when you start working, you’ll start remembering the codes you use most often. Robin ---
**Author:** ![ms\_mom67](https://avatars.discourse-cdn.com/v4/letter/m/bc79bd/32.png) [@ms\_mom67](https://boards.straightdope.com/u/ms_mom67)\ **Post date:** [February 3, 2005, 9:04pm UTC](https://boards.straightdope.com/t/ask-the-medical-billing-specialist/287880/29 "2005-02-03T21:04:51Z")
> [@Indyellen](#): > > Good luck…it takes getting used to, but once you understand how the book is organized, and know your medical terminology, it’s not TOO bad. Remember, too, that in most cases you’ll end up being given the diagnosis code (or at least a full diagnosis) by the doctor. It’s the _additional_ diagnoses that can get confusing. I’m better with procedure coding than I am ICD-9, but I have more practice at that. > > I wish you well with your classes! 😃 Well the medical terminology helped a whole lot. I had two terms of that and on my second term of anatomy. I basicly understand the lay out of the ICD-9. But how we are being taught is by getting a list of diseases or notes from a doctor and we have to pick out the info. That part is hard. But I guess that is the best way to be taught how to do this. [Previous page](https://boards.straightdope.com/t/ask-the-medical-billing-specialist/287880.md?page=1)