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Coastal Practice Medical Management has interviewed countless candidates that have just graduated from a medical billing school and coding school. As a rule, we find that the courses in medical billing school (and coding school) add little value or knowledge to the resume of an individual with no medical billing experience. Typically graduates we hire from medical billing school start in our apprenticeship program alongside individuals that have not enrolled or graduated from medical billing school (i.e., they start in the exact same role as folks that have not made the investment in money or time for medical billing school).

The terminology and concepts taught in medical billing school no more prepare a person to be a full-fledged medical biller than reading a book on how to drive a car prepares one for the challenges of actually driving a car - it is practice behind the wheel that is required. The academic elements can be helpful - just like supplementing practice behind the wheel with a manual on safe driving makes sense. Unfortunately, however, this is only true if the academic material is accurate. We have found that often students have been damaged by medical billing schools that either teach incorrect medical billing concepts or leave the students with a sense that they have nothing left to learn.

Most individuals would be much better off saving their money and finding a medical billing company ormedical practice that will let them join and start with basic medical billing work such as calling on claims to verify status or verifying patient insurance information before the visit. Both of these activities give individuals a solid base for launching a medical billing career.

If you approach organizations with this plan in mind it is quite likely that you can find an entry level opportunity. Such an opportunity will allow you to earn an income while learning medical billing and will look much better on your resume than medical billing school.

Once you have established skills as a medical biller, then it can be helpful to study for and take a certified coder exam. A certified coder with no medical billing experience, however, is not in great demand.

So, if you want to break into the field of medical billing please consider pursuing an apprenticeship model it will serve you (and your future employer) much better than a medical billing school education.

From the OIG:
One of the most common risk areas involving billing services deals with physician practices contracting with billing services on a percentage basis. Although percentage based billing arrangements are not illegal per se, the Office of Inspector General has a longstanding concern that such arrangements may increase the risk of intentional upcoding and similar abusive billing practices.

A physician may contract with a billing service on a percentage basis. However, the billing service cannot directly receive the payment of Medicare funds into a bank account that it solely controls. Under 42 U.S.C. 1395u(b)(6), Medicare payments can only be made to either the beneficiary or a party (such as a physician) that furnished the services and accepted assignment of the beneficiary’s claim. A billing service that contracts on a percentage basis does not qualify as a party that furnished services to a beneficiary, thus a billing service cannot directly receive payment of Medicare funds. According to the Medicare Carriers Manual Section 3060(A), a payment is considered to be made directly to the billing service if the service can convert the payment to its own use and control without the payment first passing through the control of the physician. For example, the billing service should not bill the claims under its own name or tax identification number. The billing service should bill claims under the physician’s name and tax identification number. Nor should a billing service receive the payment of Medicare funds directly into a bank account over which the billing service maintains sole control. The Medicare payments should instead be deposited into a bank account over which the provider has signature control.

The problem with what the OIG says is that they use two different terms when they should be using one. They say the billing service cannot have sole control... the provider must have signature control. (the second set of bold/underlined text). However, the OIG also says the billing service cannot take money without it FIRST passing thru the doctor's control (first set of bold/underlined text). If you are taking your money FIRST and then transferring the rest to the doctor then you have violated that provision.

A Medical Billers venture

Percentage based billing issues

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