Medical Billing & Coding: How it Works and Why It’s So Important
Posted On March 5, 2019
As the healthcare industry and our population continue to grow alongside are that is the growth of our demands and needs. And there is a pressure to meet that needs. There is also a demand in the need for more medical coder and biller. Medical coding and billing are how those in the medical field keep track of data that is involved in the medical procedures and keep the flow of information efficiently between the insurance company and medical service providers. Imagine the paperwork.
Medical Coding is similar to being a translator. A coder takes the doctors’ diagnosis or a prescription for a certain medication and translates it into an alphanumeric or numeric code. There are specific codes for each ailment or injury. Every code has a set of guidelines and rules. The coding process ends then the coder enters the code to the software or program. The medical coding professional transfer the codes to them from the source to the medical billing system. For example, a case on an orthopedic patient it will be passed on to the billing as orthopedic billing services. Coding is a critical job for it may indirectly affect medical care particularly those related to insurance and finances. Having proper ensures that insurers will have all the right codes required for a certain payment.
Types of medical codes:
Once a patient is examined by a doctor, and has undergone a certain procedure, a medical coder must assign a certain code for these actions. Example of which are listed below.
- Current Procedural Terminology (CPT)
- International Classification of Disease (ICD)
- Healthcare Common Procedure (HCPC)
- International Classification of Functioning Disability and Health (ICF)
- Diagnosis Related Group (DRG)
Medical billing and coding are a very important and critical part of the medical practice. You need accuracy in this job. This is critical to the safety of the patient, payment and efficient operations. This job entails professional skills. This includes people or professional who can interpret, record, read and track complex and important medical information, strong attention in details and can maintain patient’s confidentiality.
What do a medical biller and a coder do?
The coder and the biller have generally the same function. From the physician’s office to clinics to hospitals they use medical codes to document diagnoses and treatments. Medical coding and billing specialists are responsible for making sure that the medical office revenue cycle runs smoothly.
Their duties include:
- Reading and Analyzing patients’ records
- Determine the right codes for the patient
- Use the right code to bill insurance providers
- Interact with physicians to ensure accuracy
- Keep track of the patients’ data
- Manage detailed, specifically-coded information
- Maintain patient confidentiality and information security
Medical Billing is another important component in healthcare practice because it ensures the smooth operation of the revenue cycle. It is not an easy task considering that there are a lot of particulars that you need to put into consideration. One mistake will affect your entire calculations. It is a process of submitting and following up claims on health insurance companies to receive payments for services rendered by a certain healthcare provider. A medical biller’s duties differ in the size of the work facility. The biller takes care of the data pertaining to the bills. This includes claims transmission, insurance follows up, payment posting, charge entry and patient follow up.
In summary, medical billing and coding are important because they ensure accurate payment for physicians up to creating a reliable record of a patient care history.