The healthcare industry plays a pivotal role in our lives and is expected to continue booming. Moreover, the services offered and technologies used have developed over the years. Patients are extended services and world-class care, with hospitals striving to build state-of-the-art institutions. A career in medical coding and medical billing are lucrative, come with a wide range of opportunities, and are crucial to the healthcare industry. Let us look at what these terms mean and discuss their importance.
What are Medical Coding Services?
Medical coding services are a vital aspect of healthcare insurance reimbursement allowing the healthcare provider to process the bills without error. Mainly, a medical coder translates crucial medical information into simple codes, allowing efficient analysis and tracking of a patient’s health records.
What are Medical Billing Services?
Medical billing services are crucial to the functioning of a hospital or medical office. The department prepares billing claims and submits them to the insurance providers, ensuring the hospital/office is reimbursed correctly for the services they provide.
The medical coding and billing departments use software to keep track of a patient’s medical records. Thus, they keep the records updated about the diagnosis, ensuring the process, including the payment, is smooth. Medical billing and coding services are in place for the convenience of the patients and healthcare institutions. They ensure that the patient gets undivided attention and the diagnosis needed. Let us look at the importance of medical coding and billing in today’s healthcare industry.
What is the Role of Medical Coding and Billing in Healthcare Today?
Medical Coding and Billing can be viewed as minute jobs, but they impact the complete system of a healthcare facility. Moreover, these services help patients get the care they deserve without worrying about insurance claims and the revenue model. Let us look at why these services are essential.
Enables Proper Care and Treatment of Patients
Medical coding directly relates to how a patient’s conditions and treatment outcomes are stored. The patient’s medical particulars, including medications, procedures, treatments, and diagnoses, are converted into alphanumeric codes. Moreover, the data is sourced from their lab reports, medical notes, transcriptions, electronic records, and assessments. Proper documentation of the same makes it easier for doctors to treat the patient without any mishaps. In the case of medical billing, the documentation is necessary to provide insurance providers with a detailed justification of the patient’s diagnosis and treatment to ensure proper reimbursement.
Arranges and Ensures Proper Payment
The complete diagnosis and treatment is a tripartite process that includes the patient, the healthcare provider, and the payer (mostly the insurance company). The medical biller discusses, arranges proper payment between the involved parties, and ensures proper payment of services to the hospital/medical office.
Interprets the Patient’s Insurance Coverage and Makes Claims
Different types of health insurance cover certain surgeries and treatments, while others do not. The medical coder presents the procedure and diagnosis codes from the patient’s details. The procedure codes are Current Procedural Terminology (CPT) or Healthcare Common Procedure Coding System (HCPCS) codes, informing the payer about the services provided. Additionally, the Diagnosis Codes are International Classification of Diseases (ICD) codes, detailing the patient’s medical needs. These codes are used by medical billers to check the patient’s insurance coverage and further utilize them to prepare an accurate claim.
Ensures Regulatory and Contractual Compliance
It is possible that medical coding and billing fall under national and state guidelines, the most significant being HIPAA. The Health Insurance Portability and Accountability (HIPAA) act values patient confidentiality and requires healthcare providers to safeguard confidential information. Accurate coding and billing ensure that the healthcare practices and claims follow these regulatory compliances. Moreover, contractual guidelines might exist when a practitioner and an insurance company sign a contract. Thus, medical billers and coders need to check that they comply with the agreements to avoid mishaps.
A dedicated medical coding and billing department can save a healthcare provider from violating any guidelines in place. Scrutiny and detail orientation on their part can help reduce the denial of claims, improve the collections rate, reduce the time needed for the reimbursement, and boost the cash flow. However, some things to take care of are:
- The coder should be familiar with the process and the codes used.
- The billers and coders should have proper certifications and authorization from the mandated bodies.
- They should be aware of the different metrics and the process deadlines to ensure a smooth process.