The Most Important Medical Billing Associations - What You Need to Know
A list of the most important medical billing associations, with a medical billing expert's explanation of each one...
When you become a medical biller and coder, as in every other profession, continuing education and professional support play a big role in your everyday work environment.
This professional support is especially relevant in medical billing and coding, which is fast-paced and changes rapidly. Once you feel like you have the hang of certain coding situations or billing nightmares, rules, guidelines, and laws pass that make you rethink what you do on a daily basis!
But rather than being discouraging, this quickly-changing environment is a great way to keep your mind and skills sharp.
It is important, however, to stay in compliance by consulting important medical billing and coding associations, which help to keep you on track, as well as provide continuing education opportunities.
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Medical Billing Basics
Below are some medical billing associations we recommend you become familiar with.
Our experts have provided an explanation of each, including what they can help you with and why they are important to you as a well-educated medical biller or coder.
1. State Department of Insurance
Because state laws vary so widely, insurance and billing guidelines will also vary, according to the local state government which you work in.
No matter which state you live in you should have access to a state department of insurance. They'll be able to help you locate and use state laws regarding medical billing, insurance regulations, and HIPAA privacy concerns.
If you're new to medical billing, your state department of insurance is your first stop in the search for accurate and up-to-date information about the rules and regulations you should stick to.
Even if this department doesn't have the exact information you need, they'll still be able to direct you to where you need to go to find all the information you'll need to solve your problem.
Your state department of insurance is also a great resource if you're having problems negotiating, dealing, or communicating with an insurance company.
This includes when you're having specific problems getting claims paid, or if you have complaints about the way an insurance company is processing your claims.
In the exact same way that your state department of insurance knows the rules and regulations that you as a medical provider have to follow, they also know the rules and regulations that insurance companies have to follow.
Because of this, they can direct you to more information about lodging formal complaints about insurance companies, and help you in your dealings with them.
2. Local Medical Association
Your local medical association will also have a wealth of information about the rules and regulations you have to follow, as well as the rules and regulations that insurance companies have to follow. They are a great resource for you as a medical billing professional.
Unlike your state department of insurance, however, your local medical association may or may not be state-wide. You'll probably also have to register with them.
In other words, to get their professional advice and assistance you'll likely have to pay a small annual fee and become a member of their association.
But what this means is that this medical billing association is made up of medical billing and coding professionals - just like you - who may have further advice and insights on the complicated world of healthcare. These associations usually also offer face-to-face meetings and seminars to keep you up-to-date.
3. Professional Specialty Academy
No matter what type of medical office you work for, chances are that there is a professional, specialty-specific medical academy that helps providers just like yours.
For example, in Pediatrics, providers can become members of, and receive important professional advice and updates from, the American Academy of Pediatrics.
The same goes for almost every other medical specialty. From Dermatologists to Ear, Nose, and Throat doctors, every specialty has an association that helps maintain the integrity of the field as a whole. This is their professional academy, which is specific to their area of expertise.
As well as providing important updates, advice, and creating an open forum for professional discussion, these academies also serve to inform and regulate insurance companies.
Sometimes their influence is so great that they can actually change the way insurance companies do business and process claims. This makes it easier to provide the best care with the highest rates of payment for providers.
4. Coding Institutions
Another great resource, especially for medical coding specialists, are coding institutions.
This is usually the coding institution that gave you your certification.
Besides educating professional on coding and important coding changes and updates, these institutions provide a great national forum for continuing education in all areas of the healthcare industry, as well as news, discussion forums, and a wealth of other information.
Even if you're not a certified coder or don't plan on becoming one, these institutions are a great resource for anyone in the healthcare field, providing accurate, up-to-date information on all aspects of healthcare.
The 2 main institutions are AHIMA and the AAPC.
5. Federal Guidelines and CMS
Lastly, we can't forget about the federal rules and regulations that you must abide by in the medical billing and coding profession.
These include important federal laws, such as HIPAA privacy regulations, as well as diagnostic and procedural rules that you have to follow if you are a Medicare or Medicaid provider.
CMS, the Center for Medicaid and Medicare Services, is the federal body that regulates all aspects of both Medicare and Medicaid.
As such, they set the rules for all providers who see Medicare or Medicaid patients, including the very specific guidelines that you have to follow in certain specialties.
CMS is also a great open national resource that provides the last word on fees for medical procedures, as many insurance companies use CMS fee schedules as a basis for payment on their own fee schedules.
No matter where you work in the medical billing and coding professions, all of these important medical billing associations are available to you for professional support, advice, and education. They are all great resources to make you the best possible medical biller that you can be!
If you're stuck, have a look at our page on finding medical coding help.
We also recommend the ebook The Basics of Medical Billing for getting a good grasp of the industry.
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