FUNDAMENTALS OF MEDICAL BILLING AND CODING

Medical billing and coding schools Los Angeles are separate processes, but both are crucial to receiving payment for healthcare services.

Medical coding involves extracting billable information from the medical record and clinical documentation, while medical billing uses those codes to create insurance claims and bills for patients. Creating claims is where medical billing and coding intersect to form the backbone of the healthcare revenue cycle.

The process starts with patient registration and ends when the provider receives full payment for all services delivered to patients.

The medical billing and coding cycle can take anywhere from a few days to several months, depending on the complexity of services rendered, management of any claim denials, and how organizations collect a patient’s financial responsibility.

Ensuring provider organizations understand the fundamentals of medical billing and coding can help providers and other staffs operates a smooth revenue cycle and recoup all of the reimbursement allowable for the delivery of quality care.

MEDICAL CODING:

Medical coding starts with a patient encounter in a physician’s office, hospital, or other care delivery location. When a patient encounter occurs, providers detail the visit or service in the patient’s medical record and explain why they furnished specific services, items, or procedures.

Providers use clinical documentation to justify reimbursements to payers when a conflict with a claim arises. If a service is not sufficiently documented in the medical record by providers or their staff, the organization could face a claim denial and potentially a write-off.

The ICD-10 code set has two components: the ICD-10-CM (clinical modification) codes for diagnostic coding, and the ICD-10-PCS (procedure coding system) for inpatient procedures performed in the hospital. 

There are more than 70,000 unique identifiers in the ICD-10-CM code set alone.  The ICD coding system is maintained by the World Health Organization, and is used internationally in modified formats.

MEDICAL BILLING:

Medical billing begins when a patient registers at the office or hospital and schedules an appointment. At check-in or check-out, billers or other staff should also collect copayments, when applicable. Provider organizations should collect copayments while a patient is in the office or hospital to ensure timely collection of patient financial responsibility.

Part of the front-end medical billing process also involves confirming patient financial responsibility. Medical billers and patient financial services staff verify requested services are covered by a patient’s health plan and submit prior authorizations when necessary.

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