Medical coding and billing is soon becoming the most essential part of any healthcare organisation’s revenue management. Imagine getting lost in a room filled with files, records and hard copies of the bills to determine the payment process, today everyone is modernising the payment process and revenue cycles by bringing in technology in order to achieve extreme ROI from each medical business endeavour, Online medical coding and billing help you streamline your financial streams and get maximum benefit out of your payers.
Technicians who are expert in Medical billing and coding sift through all your paper work like patient’s diagnosis, their charts, prescriptions and by using diagnostic manuals and specialised computer programs find the appropriate code which is understood by all the programs designed for this purpose and data is then keyed in for a transparent and more uncomplicated process. Post all the coding is done and the data is in your system the further work starts namely by preparing the needed paperwork to file for claims with insurance companies for full and final payment.
Let’s take you through the process of medical coding and what it entails-
To explain in the most basic layman’s term Medical coding can be compared to translation. How when we read a language we don’t understand the we through various tools look for its translation for us to understand correctly similar way it’s a coders job to collect something which is written in a certain way like a report given to a patient, prescriptions written by various doctors and may be the diagnosis given by a doctor and convert it into a more universal language understood by systems and programs in the form of alphanumeric and numeric codes. The system defines a code for every procedure and diagnosis which remains same throughout the world and all the insurance companies correspond to it in a more systematic and straightforward manner.
Every professional involved in your revenue cycle management is aware of these codes, there are millions of codes for every diagnosis, outpatient procedure and medical procedures. Let us take you through how it works on a day today basis.
A patient meets with a doctor to look into a condition that he is facing, it could involve having a high fever and runny nose, shivering etc the doctor writes to get a few tests done and come back with a proper report, the nurse takes his blood and gives out a report, doctor examines the patient thoroughly looks at the reports and concludes a viral infection. The doctor then writes his prescription for the patient to get a few advances tests done and medication to be taken.
A person is dedicated to note the whole process, records every part of this patient’s visit and hand it over to a professional coder that you have inhouse of a third party who handles medical billing and coding for you and then it’s their job to convert every part of this process into numeric and alphanumeric codes which at the time of billing can be referred to and used for appropriate payment process.
Numerous sets and subsets of these codes exist, and a professional medical coder must be well versed with all of them in order to create an efficient coding. There are two main coding sets that are recognized globally. ICD and CPT are the two main coding systems that are followed throughout the world especially in the US. ICD means International Classification of Diseases and CPT corresponds to Current Procedure Terminology, both give us a fair idea of the services offered for the patients and the procedures performed by the healthcare providers. The codes are recognized as a universal language amid the hospitals, doctors, insurance agencies, clearing houses and other parties involved.
Specific rules and guidelines are adhered to while determining the right code for the visit or the diagnosis that has happened. Sometime the patient has a pre-existing condition, and which can lead to a more advanced stage of some other disease so that also must be accurately handled by the coder, with the designed guideline as it can affect the claim status. One code entered wrong can alter the revenue and patient’s end of the bargain.
The job of a medical coder comes to an end as soon as he enters the appropriate codes into the system/software program and then the coded report is handed over to the medical biller and that what we are going address next, Medical Billing.
It sounds easy after understanding a coders job, but it also includes a lot of complicated steps that if mishandled, can lead to severe problems in your revenue management. A medical biller takes the codes from the coders and prepare a claim, in simple language a bill for the insurance company to process. Immense care must be taken while preparing claims as it is one of the most crucial blocks in getting your money out of any insurance setup and if an error is committed then it can lead to denials or rejections.
Patients have different payment arrangements with the insurance company sometimes it is a co-pay process where in the patient must pay their share, so the biller has to accurately assess the shares and pass on an accurate bill to the patient. Biller must be extremely cautious while doing all this as any blunder can lead to payment delays or claim problems.
In any case if the patient is unable or unwilling to pay their share then the biller appoints a collection agency in order to procure the payment and ensure that proper compensation has been granted to the healthcare provider.
Between coder and biller lies the key to a well-functioning revenue management system. A biller has many responsibilities and if put simply he is the one that makes sure that the money that you deserved rightfully comes into your account.
Medical billing and coding is complicated yet if it is done correctly, by the team of experts it can lead to a very effective and efficient revenue channel which can help you build a system free of any errors and dysfunctionality.