Medical Billing and Coding

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Basically, in the modern health care industry medical billing and coding are two closely related aspects. In the immensely important reimbursement cycle, both practices are involved that provide the surety about health care providers who are paid for the services they perform. Look at them as separate pieces of a larger process for the sake of simplicity and divide the two moments into two different parts.

Medical Coding

Medical coding is itself a little like definition or translation. Generally, this is a coder job. The coder takes something that’s written on the way for example a doctor diagnose the patient and prescribed certain medication, and then translates it accurately into the numeric and alphanumeric code as well.

In the medical coding language, there are thousands and thousands of codes. Moreover, there are a lot of codes, outpatient procedures, and also the diagnosis.

Example

Let’s note an example to understand the medical coding process more conveniently.

  • A patient walks with a hacking cough into a doctor’s office . Also, he has high production of mucus or sputum including fever.
  • A nurse asks the patient about his symptoms and performs some initial tests.
  • Then, A doctor check, examines, and diagnoses bronchitis.
  • Doctor then prescribed the medication to the patient.
  • In the healthcare provider’s office, every part of this visit is recorded by the doctor.
  • Now, the medical coder’s job is to translate completely every bit of relevant information. The patient’s visit code is converted into the numeric & alphanumeric code.
  • Then the code can be used in the billing process.

Remember that every code has its own set of rules and guidelines. To signify a pre-existing condition certain codes need to be placed in a very particular order. Don’t forget that accurate coding according to specific guidelines will affect the status of a claim. When the medical coder ends the appropriate codes into a form or software program then the coding process ends.

  • Once the report is coded, then it is passed to the medical biller.

Medical Billing

Medical billing is very simple as it sounds. The medical billers get the information from the medical coder and then make the bill for an insurance company which is called a claim.

  • However, as it looks so simple related to the other health care system this is not too simple as it seems. So, let’s rewind the previous example to get more clarification and a better look. The same patient with the same problems (cough, fever, and producing a lot of mucus), calls the doctor and schedules an appointment. Now at this moment, the medical billing process begins.
  • The medical biller may have to hire a collections agency in the case of a patient being delinquent or unwilling to pay the bill, which ensures that the healthcare provider is also compensated properly.
  • Therefore, the medical biller acts as a sort of waypoint among healthcare providers and patients.
  • As a sort of translator you can think of the biller, like a coder where the coder translates the medical procedure into the code. Then the biller translates the codes into a financial report.
  • Healthcare provider is properly reimbursed for their services, so you should simply know that the biller is in charge of making sure about healthcare services.
  • The Medical billing and Coding Certification is issued to the patient as he/she getting the insurance of medical services as well.