The Process of Medical Billing and Coding
Healthcare providers are very important to everyone. They are the
ones people go to when they have health problems, injuries or if
they need medication. They also help patients in maintaining their
health and prevent diseases. Patients usually have medical insurance,
which they use for their hospitalization or treatment. The insurance
provider will then pay the healthcare providers on everything that's
under their coverage. The billing process is a long one. It usually
takes several weeks or even months before it gets settled. This can
be very inconvenient to healthcare providers if they take care of the
process on their own, as they are busy with their work. This is why
they hire medical billers and coders to do their billing and coding.
Healthcare providers can hire a medical biller to do the billing and a
medical billing and coding jobs to do the coding. Sometimes, they
hire only one person to do both medical billing and coding, though this person is paid higher
since he has more responsibilities. The medical coder is responsible for translating the details of
the patient's medical record into medical codes. The details include the diagnosis, treatments and
procedures made during the hospitalization. The coder use standard codes from two manuals.
The ICD-9 or International Classifications manual is for coding diagnoses and the CPT or
Current Procedural Terminology is used for coding procedures.
More information can be found here.
The medical biller will then send the billing to the patient's
insurance provider. Sometimes, patient has corresponding amount
that they need to pay. For instance, if they have deductibles or
coinsurance, the amount will be deducted to the total bill. The
medical biller will also send a billing to the patient with the
corresponding amount that they need to pay. It's also their responsibility to explain to the patients
what the bill is for, if ever they have questions. They can also negotiate on the terms of payment
as well as the collection.
Some hospitals use a program for automatic billing. The program will read the medical billing
jobs and input the necessary codes. However, a medical coder would still usually double-check
them for errors. Billing and coding should be done accurately to get the payment faster. If there
are any errors, the insurance provider may reject or deny the request, which usually includes an
explanation on why it's denied or rejected. If there are problems with the codes, the coder must
make necessary corrections. If there are errors on the charges, the biller must make proper
adjustments then send it back to the insurance provider until its approved and paid.