Medical coding and billing is a field in healthcare industry, where an individual need
not spend years learning in school and yet master his skills in it. You will find them in
various healthcare settings such as: doctors' dispensaries, private or public hospitals,
dental practices, pharmacies, laboratories, etc. Playing a significant part in the
healthcare industry you will also find Medical coding and billing specialists running
their own business. Medical coders ensure exact analysis of patient diagnosis as well
as about its procedures whereas medical billers ensure that insurance agencies,
providers of workers' compensation, Medicare and Medicaid timely receive patient
reimbursement forms. You will find many of them skilled in both areas as medical
coding and billing.
Also referred as medical analysis is a process where for medical procedures and
diagnosis specify its universal codes in alphanumeric or numeric form. Medical
coders refer to patient’s medical record available in department, lab technology
reports as well as doctor’s report for determination of procedures and diagnosis to be
coded. Coders track down details of injuries or diseases and procedures adopted for
the treatment given to patients. Medical codes are used on reimbursement claim forms
to be submitted to insurance agencies, on diagnostic request forms and Medicare and
Medicaid for payment of claims. It is also used for internal facilities for healthcare
service provider for the purpose of research as well as marketing.
Medical billing is a process handled by medical billing specialist who represents
claims to health insurance agencies to confirm reimbursement to a patient for the
services provided by a healthcare service provider. They also follow up and deal with
problematic issues of patients on unpaid claims with insurance agencies, Medicare
and Medicaid. Medical billing process remains same regardless of whether the
insurance agency is privately owned or is owned by the government.
Qualifications of medical billing and coding specialist
In the healthcare industry the profession of medical coding and billing specialists is
heavily in demand. Medical billing specialists with a Bachelor's degree in health
information management or equivalent are placed higher at management positions,
though they may not possess substantial practical knowledge or experience. You will
also find the medical coding and billing specialists who possess a relevant diploma
course or a certificate.
It is essential for a medical billing specialist to have detail knowledge and
understanding of HIPPA an abbreviation of Health Insurance Portability and
Accountability Act for which they also receive training. The act protects patient health
information privacy whether it is in spoken, written or in electronic form and can
adversely affect many levels working in the healthcare industry.
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