A medical billing specialist is an individual or business who's sole purpose is to process billing on behalf of providers. 

They can work directly for a practice, or be an individual or business that provide this service on an as needs basis.

Billing specialists vary between only working with providers in certain specialities, to billing generalists who have extensive experience across many areas of medical billing. 

As billing specialists are dedicated to being across all changes that affect medical billing, changes to item numbers and fees, as well as understanding and deciphering complex rules and regulations, you can be assured that billing compliance is at the forefront of all of their processes.

Billing specialists are valuable to most providers other than GP's (for consulting) and Allied Health.

These include (but not limited to):

• Surgeons
• Assistant Surgeons
• Anaesthetists
• Rehabilitation Specialists
• Acute Inpatient and Emergency Medicine Specialists
• Public Health Consultant Specialists with regular private and on-call lists
• Private Consultant Specialists that undertake home visits, regional/rural work or consult from various locations
• Inpatient Psychiatrists
• Inpatient Diagnostics
• Nurse Assistants

While this can vary from billing specialist to billing specialist, most will perform the following billing tasks for you:

• Bill Medicare/DVA
• Bill health funds via ECLIPSE (and known gap billing)
• Bill workers compensation and Third Parties
• Bill Private and uninsured patients
• Informed financial consent and estimates management
• Prepayment management, including known gaps
• Online patient claims submitted to Medicare and two-way to health funds
• Online credit card payments for patients
• Follow-up unpaid claims, third parties/workers compensation and patient invoices
• Registration with health funds (if needed)
• Monthly reporting.

One of the questions that gets asked over and over again when it comes to engaging billing specialists, is where is my billing income deposited.

While again this varies from billing specialist to billing specialist, many follow the below methodology:

• Income paid from online claims (ECLIPSE and Medicare/DVA bulk billing) is deposited directly into your bank account
• Invoices paid by credit card with a merchant facility provided by you will be deposited into your bank account (but access is required to daily transaction reports)
• Invoices paid by credit card with a merchant facility provided by the billing specialist will be deposited into your account in a lump sum on a set schedule - e.g. monthly, twice a month, weekly, etc
• Invoices paid by EFT is usually paid into a holding account in the name of the billing specialist. Funds will be deposited into your account in a lump sum on a set schedule - e.g. monthly, twice a month, weekly, etc

How a billing specialist charges you varies from service to service.

The main methodology employed by businesses who provide billing specialists is to charge a flat percentage based on the monies you have received during the period.

Where variances lie is that some billing specialists have a minimum invoice fee, and some have additional fees for different service inclusions.

Other ways in which you may be charged include by the hour, and based on the value of invoices raised (not what you have received payment for).

One of the main advantages of being charged a flat percentage of monies receipted is that you know exactly how much of your cashflow will be spent on ensuring your billing is handled as the top priority.

Med AR charge a single, flat percentage for all monies receipted during a month. We have no minimum charge or lock in period. For example, if we receipt $10,000 in a single month and we charge you 4%, your fee would be $400 for that month.

All outsourced billing specialists will have a method in which they advise you that your billing has been completed.

Some may simply be providing you with reports at the end of the month outlining what has been billed and what has been paid. 

Others have portals and apps that allow you to track your billing.

Nonetheless, all provide you with some method of reassurance that your billing is being completed.

One of the most common misconceptions about engaging billing specialists is that only providers who do not have rooms or staff benefit from a service like this.

This could not be further from the truth. And in fact, surgeons, hospitals and health services are increasingly seeing the benefit of engaging a billing specialist alongside their practice managers and teams. They are afforded peace of mind knowing exactly when their billing will be processed, that rejections and outstanding payments are being actively managed (and not when they have time to sit on hold), and exactly the cost to them.

Benefits of engaging a billing specialist include:

• Knowing that your billing will be completed in a set time frame from submission, providing cashflow certainty
  
• Fill in-house roles easier with no requirement for them to have billing expertise
• No pause to your billing (and cashflow) due to personnel leave
• In-house staff focus on patient care and management (not business processes and procedures)
• Comprehensive monthly income reporting

Sending your billing information is usually a pretty simple process.

For billing related to providers involved in surgery, in many instances a theatre list contains all the information need to process the billing. For many, the only additional information to be added is the item numbers (if different for assistant surgeons and surgeons, and the right items for anaesthetists).

For consultant specialists, much of the information can be found on a hospital BRADMA or patient intake form. The additional information that needs to be added includes the date of service, the item numbers and email address for the patient.

Many billing specialists will provide you with guidance on how to collate the relevant information - such as providing a billing spreadsheet. Many then have you email or upload this information across to them for processing.

Most billing specialists have transitioned into this role or business after years of experience working in a practice and managing the billing for a provider.

They know the ins and outs of billing rules, how to successfully resolve claims and follow-up outstanding invoices.

While in Australia there is some formal training options, most learn on the job.