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Essentials of Medical Billing and Coding

Essentials of Medical Billing and Coding

Medical billing and coding are two of the most critical components of any healthcare services. Accuracy in both of these areas is critical to patient safety, rapid payment, and efficient operations.

Let’s look at some of the ways medical billing and medical coding are essential to modern medicine.

PATIENT CARE

Medical coding takes information about diagnoses, treatments, procedures, medications, and equipment and translates them into alphanumeric codes. This information comes from a range of sources, including transcriptions, medical notes, electronic records, lab results including blood work, urinalysis and pathology, and radiologic assessments.

REGULATORY AND CONTRACTUAL COMPLIANCE

Medical billing and medical coding fall under many state and federal guidelines. Perhaps the most significant is the Health Insurance Portability and Accountability Act (HIPAA). HIPAA protects patient confidentiality, requiring any medical practice or hospital to take safeguards to protect confidential patient information. HIPAA guidelines also cover electronic medical records and the International Classification of Diseases (ICD-10) uniform diagnostic codes issued by the World Health Organization (WHO).

ENSURING PAYMENT FLOW

Medical billing is an important component of practices, ensuring the smooth operation of the revenue cycle. Medical billers have to understand different medical regulations and private and public insurance plan policies. They need specialized knowledge of claim follow-up, claim denial resolution, posting payments and bill adjustments, appeal submissions, and collections management. The efficient management of these components ensures improved revenue flow throughout the practice.

WHAT IS MEDICAL CODING?

Medical coding starts with a patient encounter in a physician’s office, hospital, or other care delivery location.

THE IMPORTANCE OF ACCURATE MEDICAL CODING

Accurate medical coding is necessary if you expect to obtain insurance reimbursement. It’s also important to maintaining the records of your patients. There are some potential problems that you can run into as a result of errors in medical coding as well. For example, Over coding can cause serious problems. Over coding happens when you report medical codes that actually result in a higher payment being made by the insurance company. This could be considered fraud, which, in turn, could result in both legal and financial penalties.

WHAT IS MEDICAL BILLING?

While coders are busy translating medical records, the front-end billing process has already started.

FRONT-END MEDICAL BILLING

Medical billing begins when a patient registers at the office or hospital and schedules an appointment. From a revenue cycle perspective, getting the most accurate information up front starts with patient scheduling and patient registration.

BACK-END MEDICAL BILLING

Together, medical coders and back-end medical billers use codes and patient information to create a bill. The bill is an itemized form that providers use to create claims.

OUTSOURCING YOUR MEDICAL BILLING AND CODING

Medical billing and coding are integral healthcare revenue cycle processes. Leaving your staff in charge of medical coding is not always the best idea, especially if they have other responsibilities within your practice. It can be difficult for them to keep up to date with coding changes.

By outsourcing, you will be ensuring that the medical billing and coding cycle run smoothly. It ensures that providers get paid for services delivered and provider organizations remain open to deliver care to patients.

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