Advocacy Careers: Medical Bills or Claims Reviewer

Medical Bill Reviewing Is a Form of Patient Advocacy

Patient filling the papers of insurance at the hospital
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American patients, especially those dealing with any private form of insurance, likely have medical bills to pay. In all likelihood, those bills contain mistakes of some sort.

Research shows that as many as 80% of hospital bills contain mistakes. Further, the estimate on billing fraud - that means money being billed for services that were not provided - is estimated to be 10%. Statistics like these help us understand why one growing area of patient advocacy is medical bill reviewing.

With so many errors occurring during the billing process, it is extremely important to carefully review your medical bills.

Medical Bill Reviewers

Medical bill reviewers can reap rewards for patients (as customers) and the reviewer as well, as being a medical bill reviewer could be a good career choice. Patients and caregivers will hire medical bill reviewers to help them go through their bills to find mistakes that could be costly and help those patients coordinate with whatever entity sent the bill to settle for the amount due - and no more.

There are several names medical bill reviewers use for their services:

  • Medical Billing Advocates
  • Medical Bill Reviewers
  • Medical Bill Navigators
  • Medical Bill Consultants
  • Claims Assistance Professionals
  • Medical Claims Advocates
  • Medical Claims Consultants
  • and others

The goal of their work is to make sure the bills received by a patient are accurate and fair. The $75 box of tissues billed to a hospital patient - twice - will probably be removed or the cost will be reduced.

The $950 MRI - twice - may have to stay on the bill. The medical bill reviewer will do the legwork to figure that out.

Educational Opportunities for Aspiring Medical Bill Reviewers

There are few educational opportunities to learn to be a medical bill or claims reviewer. Most medical bill reviewers begin with a career as medical coders, for hospitals, private physician practices or other health or medical organizations.

Some home-study courses are available, but such classes tend to be geared toward those individuals who have coding experience.

The work of a medical bill reviewer is highly detailed. A thorough knowledge of the application of medical codes and diagnostic codes, plus the rules and procedures used by private insurers and government programs is necessary. The abilities to stay organized and to be able to communicate findings to the patients who hire reviewers is important, too.

There are two national organizations of medical billing professionals - the Alliance of Claims Assistance Professionals and Medical Billing Advocates of America.

Medical bill reviewers are mostly self-employed, running their own patient advocacy businesses.

If you are looking for a medical billing advocate to help you, you can find one in the AdvoConnection Directory.

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