WHAT IS MEDICAL BILLING AND MEDICAL CODING
Medical billing and coding are two very relevant aspects in medical industry. Both practices are involved in the immensely important reimbursement cycle, which ensures that health care providers are paid for the services they perform.
It is the coder’s job to take something that is written one way (for example prescription) and translate it as accurately as possible into a numeric or alphanumeric code. For every injury, diagnosis, and medical procedure, there is a corresponding code.
For example, patient walks into a doctor’s office with a hacking cough, high production of mucus or sputum, and a fever. A nurse asks the patient their symptoms and performs some initial tests, and then the doctor examines the patient and diagnoses asthma. The doctor then prescribes some medication to the patient.
Every part of this visit is recorded by the doctor or someone in the healthcare provider’s office. It’s the medical coder’s job to translate every bit of relevant information in that patient’s visit into numeric and alphanumeric codes, which is called as medical coding.
Medical coders should familiar with terms like international classification disease and current procedure terminology.
Every code set has its own set of guidelines and rules. Certain codes, like ones that signify a pre-existing condition, need to be placed in a very particular order. Coding accurately and within the specific guidelines for each code will affect the status of a claim.
The coding process ends when the medical coder enters the appropriate codes into a form or software program. Once the report is coded, it’s passed on to the medical biller.
MEDICAL BILLING:
Medical billing is as simple as it sounds: medical billers take the information from the medical coder and make a bill for the insurance company, called a claim.
The medical biller takes the codes, which show what kind of visit this is, what symptoms the patient shows, what the doctor’s diagnosis is, and what the doctor prescribes, and creates a claim out of these using a form or a type of software. The biller then sends this claim to the insurance company, which evaluates and returns it. The biller then evaluates this returned claim and figures out how much of the bill the patient owes, after the insurance is taken out.
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