What is Medical Billing and Coding? Your Questions Answered

January 11, 2022
by Admin

Medical billing and coding are essential to running a practice. These systems impact patient safety and accounts receivable, as well as operations and efficiency. If not optimized, coding can directly affect your bottom line.

This blog explores common medical billing and coding challenges and provides suggestions for improvement.

What is Medical Coding?

Medical coding translates the descriptions of diseases, injuries, and healthcare procedures from providers into numeric or alphanumeric codes that standardize the associated diagnoses and procedures performed.

For example, a patient walks into a doctor’s office. A nurse assesses that he has a headache, runny nose, fever, dizziness, and nausea. Next, the physician examines the patient and makes a diagnosis; afterward, the doctor prescribes drugs or recommends an extended stay in the hospital.

The doctor, or another health worker, records each step of the process, then the medical coder translates these records into codes that are used in medical billing.

Standardized Codes (ICD-10)

One of the most established series of medical codes is the International Classification of Diseases (ICD).

Used in both America’s Center for Disease Control (CDC) and the World Health Organization (WHO), the ICD codes have been an invaluable instrument for medical coders since 1893.

While the 10th revision of the list (ICD-10) has served as the standard since the early 1990s, WHO will consider approving ICD-11 later this year.

Importance of Medical Coding

Medical coding is important for several reasons:

1. Universal Shorthand

Medical coding ensures that no matter where the patient or their files go (to healthcare professionals, hospitals, insurance companies and other important organizations), the recipient will be properly equipped to understand the provided information.

Medical codes improve the accuracy of billing and diagnostics between care facilities and providers.

Using a universal language ensures that jargon from any particular field won’t complicate communication.

2. Savings for the Patient

Without accurate medical coding, patients run the risk of overpaying for medical services. By clearly rendering all services, coders are equipped to prevent overcharges or billing errors.

3. Justification for Treatment

Through medical coding, any services rendered are documented, which validates treatment. This helps patients filing insurance claims.

Accurate coders help insurance companies understand why certain charges are filed. Despite frequent and random reviews by insurance companies, this ensures that charges are justified.

4. Confidentiality and Privacy for the Patient

Even though medical coding serves as a universal health language, the information within is not easily accessible.

If unauthorized entities accessed that data, it would remain largely indecipherable without proper training.

Now, let’s take a look at medical billing.

What is Medical Billing?

Medical billing is tightly interwoven with medical coding. In many hospitals, the positions of medical coder and medical biller are filled by the same person.

Medical billing begins the moment the patient calls the healthcare provider. A medical biller uses the codes provided from the medical coding process to determine the cost of a patient’s treatment.

The biller then submits claims to the patient’s insurance company that renders payment for the patient’s services. In order for practices to receive payment from insurance companies, claim submission is essential.

Medical billing specialists manage accounts receivable, incoming and outgoing payments and insurance negotiation.

Medical billing is an important component of healthcare that ensures a smooth flow of payments and claims transactions between patients, their insurance companies and the practices that render their services.

Medical billing is important because:

1. It determines the bill.

Without medical billing, it is impossible for patients to determine their payment for treatment. If the patient’s insurance covers part or all of the total amount owed, the medical biller ensures the patient is charged appropriately.

However, if a patient’s insurance does not cover the bill, that patient is then responsible for making up the deficit.

Regardless, medical billing ensures that patients clearly understand the cost of their procedures.

2. It protects the healthcare service provider.

There are times when a patient may refuse to pay the balance owed. Medical billing makes sure the healthcare provider is paid what they are due.

The medical biller gathers the codes and submits them to the insurance payer to make sure there is adequate compensation.

In short, staff and healthcare are paid as a result of medical billing. Without medical billing, care providers would be at the mercy of the patients’ impulses.

Billing and Coding Tips

Healthcare providers must ensure their system for medical billing and coding runs effectively and efficiently; after all, their practice depends on it.

These tips will help healthcare providers maximize revenue by guaranteeing a smooth medical billing and medical coding process:

1. Stay updated.

The healthcare scene is constantly changing. To thrive, healthcare providers must remain current with changes to ICD-10 and other coding procedures.

Not doing so could result in claim denials that negatively impact your revenue stream.

2. Collect fees at the time of service.

Collecting payment up front will improve your revenue stream. Healthcare providers must remember that the longer it takes to request payment, the more difficult it is to receive it.

Medical billing should be carried out as soon as possible to make sure patients are more likely to pay willingly.

3. Collect patient information before treatment.

To avoid delays and mitigate other issues, it is wise to collect patient information before treatment.

Verify the patient’s identity and insurance card information, then update any changes to the patient’s record since their last visit (address, payment method, employment, etc.). It would be unfortunate to discover after treatment that your patient cannot pay for services.

Determine whether the procedure is covered by insurance, or the patient intends to pay out of pocket.

4. Ensure Accurate Coding

Many claims are rejected because of errors in medical coding. It can take weeks to identify, rectify and resubmit erroneous claims.

Attention to detail is key. The practice benefits from quickly filing medical billings only when claims are properly edited and vetted before being sent to insurance companies.

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