Medical Billing and Coding
The two essential parts of the billing process are medical billing and coding. As the doctor examines a patient record to be submitted to the insurance company, there are significant steps that need to be completed. Each doctor checks the results of medical coding and medical billing skills which are vital for appropriate reimbursement of services.
The Difference between Medical Billing and Medical Coding
The process of utilizing specific codes to classify procedures and services for private billing, health insurance companies, government health programs, workers’ compensation carriers, to name a few is called medical coding. To allocate the correct common code based on their coding skills and knowledge, a coder translates and reads all documentation including a medical chart or transcription of doctor’s notes, wherein the codes are entered into a form on their computer system.
These medical codes are based on diagnoses and procedures, and also exist for all types of services, tests, and treatments offered by a healthcare provider in a medical workplace, hospital, or clinic. The code for diagnosis is translated into an ICD-9-CM code, while the code for procedure is deciphered into a five-digit CPT code. There are a lot of medical codes which includes anything from a stomach ache to a broken arm.
After identifying the diagnosis and procedure codes, the medical biller hands the claim to the insurance company for payment. The process of tendering and following up on claims to insurance companies so as to receive payment for services rendered is called medical billing. To make sure that the patient and health insurance company are correctly billed for all procedures provided a billing specialist needs to carefully check it. All approved claims are reimbursed, while rejected claims are investigated and revised.
All billing specialists are required to send claims for reimbursement through electronic resources, as mandated by the Health Insurance Portability and Accountability Act (HIPAA). This technique has resulted in faster and more precise payments from insurance companies. The utilization of billing software has also allowed medical billers to execute accounting tasks and handle billing procedures more successfully. Moreover, patient records, open claims, and outstanding invoices become more accessible.
On the other hand, sometimes the process may fail in getting the pre-agreed percentage of the payment from the insurance company which requires adjustment and re-submission. A lot of claims are still processed manually which can take from two days up to a number of weeks or even longer which is a problem for healthcare providers.
Fifteen or more different types of insurance may be provided by companies which the employees must recognize with all its legal consequences of all their details. All difficult laws pertinent to the billing process on both sides of the relations must be visibly understood. Medical billing schools offer classes created to train students in all relevant requirements for the work.
The medical billers and medical coders guarantee that the billing phase or procedure is flawlessly executed from patients being billed with the right amount to the doctors getting paid. It would be very difficult to complete, monitor and handle medical claims without the help of medical billers and coders. They are both vital to the financial welfare of an organization and health care industry all together.
Job Description of Medical Billing and Medical Coding Specialists
The people whose job is to allocate unique codes that notify what procedure, service, or product that was used are medical coders. These unique codes are assigned in order for the hospital or doctor to get paid from the insurance company. To pursue a medical coding job you need to have a degree as an associate or you need to have a medical coder’s certificate. The more you broaden your knowledge in the medical coding career, the more money that you would be able to make and the better opportunities you would find.
The medical coding career is very promising for it is one job that is constantly needed. Each moment someone goes into the hospital or a doctor’s office, there is a need for a coder to be assigned for that particular visit. After the assignment of the visit, it would be sent to the medical biller.
As a medical biller, you would need to work in a hospital or physician’s office and collect codes that the medical biller has designated and encoded it to a special form to be submitted in to the insurance company for payment. This medical billing career is much more than just data entry, for you need to understand and know the meaning of the codes to ensure that the correct price tag has been attached. In order to make a medical billing professional job a lot easier, you would need to utilize a special software program where the codes and billing prices are usually saved in a database. One of the main tasks of a medical biller is to check each code entered into their software program to ensure that the exact charge, date of service, quantity, and patient name goes through to the correct insurance carrier. To develop and enhance your knowledge as a medical biller you might as well go a school and learn specific areas of billing including mental health billing, Medicare and Medicaid billing, private insurance billing, and military billing.
Careers in medical billing and coding are indeed always in demand. They are both usually getting paid well, particularly if they know both medical billing and coding.
Important Certification of a Medical Billing and Coding Specialist
The process of making claims on insurance companies as well as following up these claims to cover the medical expenses of the patient is called medical billing and coding. Medical coders are most likely employed by hospitals, private healthcare institutions, and other agencies that provide healthcare services. In general, medical coders earn a lot which is why many people would like to look for this kind of job. In order to work and qualify as a medical coder, a medical billing and coding certification is needed. Although there are some medical coders who manage to get an employment without a certificate, having one would surely provide you an edge over others since the majority of health institutions prioritize medical coders with certificates.
In order to meet the criteria for a medical billing and coding certification you would first need to pass the coding certification assessment. The examination will include all you need to know as a medical coder, including codes, HCPCS methods, and ICD-9-CM to suitably perform all assigned tasks. Nearly all coders are required to go through a formal training and education in the field of medical billing and coding. A person interested with the job can choose to get his education online especially if you do not have the time to attend formal classes, since a large number of education institutions provide programs online.
A great number of employment opportunities are available with a medical billing and coding certification, mainly due to the fact that the need for medical coders in both public and private institutions are projected to experience a stable growth in the future. Despite the fact that you cannot expect to earn so much when you are just starting out, you can still choose positions with higher remuneration once you have sufficient background or experience. It is expected that you would be compensated more if you had appropriate medical billing and coding certification by a certified educational institution.
Given that there is a lot of detail in medical coding, it is better to attain formal education to obtain a good grasp of practice and etiquettes. You can select to obtain a medical billing and coding certification through various different agencies including, American Health Information Management Association (AHIMA), Registered Health Information Association (RHIA), and Registered Health Information Technician (RHIT). The medical billing and coding certification from AHIMA is usually attained by those who are new to the industry because this agency does not require much experience. For instance, if you have valid experience as a medical coder, it is advisable for you to get a certification from the Professional Association of Healthcare Coding specialists as this institution issue certification for those who have experience and with an area of expertise in coding. Certified and professional medical coders with superior skills in specialty coding are in demand because not too many have AHIMA certification. An extensive choice of career options are available to those who has a medical billing and coding certification because it signifies that the person with this certification have obtained their education in this field and have passed all required examinations to verify that they are entitled to practice as medical coders.