How to Become a Medical Billing Advocate

If you would enjoy a medical billing career but wish to work more on the side of the patients and insurance companies getting billed for medical care, a medical billing advocate position may be ideal for you. Becoming a medical billing advocate is not very difficult and can contain the same education you would receive for a medical billing career within a medical facility. The major difference in your duties is that you won’t be billing patients and filing insurance claims, but acting as a billing consultant that looks over medical bills to ensure there aren’t any unnecessary or mistaken charges or upcoding present. Upcoding is an act that has been found to be fraudulent and consists of patients being billed for a higher level service than was actually received. This is illegal and as a medical billing advocate, you would be pointing out these errors.

Getting a Higher Education

Just like you would attend a medical coding program or related program in order to enter the medical billing specialist position, you would do the same to become a medical billing advocate. You will be responsible for learning appropriate medical terminology and appropriate codes for billing procedures. You will also be trained on the appropriate procedures for pinpointing billing errors and addressing them properly. It is a federal law that all errors must be reported by the physician to the federal regulating agencies, and you will act as the consultant that checks for these errors.

Entering Into the Position

There are many medical coding consulting agencies that offer the position to those that wish to investigate medical bills and billing procedures. Your main role will be inspection of patient bills and decoding to identify any improper charges or upcoding that have occurred. Once the issue is found, the patient as well as the physician is notified and given appropriate details for making the appropriate reporting measures to the correct agency.

Why Become a Medical Coding Advocate

In a world where health care costs are always on the rise, it is important that there are medical coding advocates to ensure that patients are only billed for the services and resources they receive and no more. You will serve as the voice for the patients, and the insurance for the insurance companies that the payments due are necessary and should have been charged. In the event that you are able to identify any type of fraud, you will be able to ensure that the issue is resolved and the patient only charged what should have been from services.

A medical billing advocate holds a key role in the health care industry with a strong influence over the future of this industry. There are organizations that go further to ensure that policies are enacted to provide security to patients from medical billing fraud. Patients may not be able to decipher medical code, so it is up to you to ensure that there haven’t been any mischarged items on a patient’s bill or insurance claim.

Be Your Own Patient Advocate Before Surgery

When planning for surgery it is useful to learn the art of being your own patient advocate. Today’s health and wellness industry has made it easy for us to obtain information to ensure we receive quality care. When we do our own thorough research ahead of time we can feel confident about having a positive surgery outcome.

How to be a patient advocate in navigating health insurance:

It is important to have a full understanding of your health insurance plan. Here are some of the things I learned this past year:

· When in need of a new insurance plan seek out a local insurance broker to help sort out the best plan for your specific needs. Free of charge, they help us attain emotional health about the coverage we choose. These agents know which plans do not raise their rates yearly, which ones are most appropriate to choose with pre-existing conditions, and which plans will be available long-term.

· Whenever you receive a new insurance plan you need to become your own patient advocate by reading through the policy right away. This will inform you if they have placed any restrictions on covering any of your current medical conditions. You do have 30 days to cancel the plan if you find the policy unacceptable.

· If a situation presents where you are not able to pay your medical bill you can make alternative payment arrangements. Those with financial hardships are able to reduce their hospital fees or perhaps waive them entirely.

How to be your own patient advocate for medical visits:

· The health and wellness industry has been great at educating us how to prepare ahead of time for a medical visit. Most of us have already experienced the value of writing down our questions before the visit. To optimize your limited time with the doctor I advise asking your practitioner only those questions they themselves can answer. As my own patient advocate I have learned to query other staff with the remainder of my questions. For example:

1. Direct inquiries about pre-post surgery issues to the surgery scheduler.

2. Ask the front desk staff how to obtain the morbidity & mortality statistics for the doctor and hospital.

· The health and wellness industry has encouraged us to have a trusted person with us during the medical visit. When another is present it allows them to become your patient advocate. I have found their presence vital since way too often my trusted friend brings up issues I failed to mention. It helps me take care of my emotional health when the trusted person is my scribe and documents the doctor’s comments.

· When you need a physician to submit a form (or write a letter) on your behalf it is best to prepare ahead of time. Here are a few examples:

1. When requesting a temporary handicapped parking permit find out ahead of time if the DMV requires you to download their form. If not, draft a letter with your request for the doctor to sign.

2. Whenever you need the doctor to write a letter confirming a medical condition it is best to become proactive as your own patient advocate. Arrive at the medical visit with a sample letter which includes all the pertinent information so you leave with it in-hand.

3. When you need a medical test ordered at another facility come prepared with the name of the facility and FAX number where the request can be sent.

When you follow these guidelines chances are greater you will leave the visit with total confidence that your needs are being handled.

How to be your own patient advocate before and after surgery:

· Know that you can request an early morning surgery when necessary. In taking care of your health and wellness inform the surgery scheduler of needs for early morning surgery if you have health issues that would be compromised when pre-surgery requirements forbid the intake of food or water. Prior to surgery it is best to take care of your emotional health and speed up the time your body is without nourishment.

· It is desirable to have a trusted friend stay in your hospital room overnight. If something unusual presents they can be of immediate value. Today hospitals have a chair that folds down into a bed for these specific purposes.

How to be your own patient advocate in finding the best surgeon:

· The health and wellness industry has made it easy for us to do research online. In your inquiry, seek out the latest state-of-the-art surgery technologies. After studying the various options you are more ready to select a surgeon.

· Search for doctors that use minimally invasive surgical techniques to reduce pain, restore mobility, and promote a quicker return to normal activities.

· In being your own patient advocate you may find the need to look outside your local area for a surgeon. Surgery is an invasive medical procedure. It is in your best interest to feel confident you will receive the highest quality of care.

· I encourage you to inquire how experienced your potential surgeon is. You want someone who has done the procedure hundreds of times to ensure the best outcome.

Hopefully you feel more feel confident about being your own patient advocate when planning for surgery. There are countless online resources available to help sort through the maze of information. Use these guidelines when seeking out what is available and you will find balance in your emotional health.

Medical Fraud: A Big Dollar Concern

With reports about identity fraud making waves throughout the news media, it’s especially important for those looking at the American health care industry to consider a specific kind of identity fraud that can be especially expensive for victims. Medical fraud is commonly defined as any kind of identity theft that facilitates the use of insurance or medical information which allows for an unauthorized individual to get access to medical insurance, medical care or other services, or that in some cases, allows for false billing or funneling money directly from the victim to the fraud perpetrator. Learning more about it can help you avoid medical bankruptcies or other problems.

The Numbers on Medical Fraud

Although it may be more obscure than other types of fraud, for instance, credit card fraud, some reports estimate that medical identity theft affects almost two million people in America each year, with an overall monetary impact of over $40 billion. Experts also estimate the costs of medical fraud per victim at over $20,000. That means that this kind of fraud can destroy the budgets of many American consumers or families who become victims of this type of identity theft.

Common Scenarios

Experts suggest that some identity thieves pursue medical fraud in order to get insurance coverage through illegitimate means, while others may be looking to get their hands on prescription drugs that they will sell on the black market. But although these kinds of situations can hit consumers or families out of nowhere, other reports suggest that in many cases of medical fraud, there’s a gray area: the victims of these kinds of fraud may have let their family members misuse their medical information or otherwise been complicit in fraudulent claims or other types of identity theft.

Medical fraud is just one way that the average American family can find itself bogged down in medical debt or otherwise trapped in eternal debt cycles. In order to prevent these kinds of nightmare scenarios, it’s important to safeguard identity information and do regular credit checks and basic financial monitoring. You can also get help from third party medical advocates that understand the health care system and how to fight various kinds of financial challenges to make sure that you and your loved ones are not taken advantage of by a system that often generates extremely high costs. Talking to these types of agencies and organizations can help you gain a better idea of how to prevent medical fraud, unfair denials or bills, or any other financial struggle that could have been avoided through good documentation and vigilance. Get the facts and protect yourself against medical fraud and unfair medical debt for a better financial future.