Healthcare professionals like doctors have to attend to many patients every day in a hospital or clinic. Most patients who visit a clinic or hospital come with a health insurance plan. To get payments for their services, doctors need to submit patients’ claims to insurance providers or companies. Doctors are so busy treating patients, that they can’t do it themselves. This is where medical bills and coding play a vital role.
Today, we will tell you everything you should know about medical billing and medical coding. This discussion is especially helpful for those who want to build a career in this field.
What Is Medical Billing And Coding?
In the intro, we already shared a little insight into what medical billing and coding are. It is an emerging and essential part of today’s healthcare field. The main role of medical billing and medical coding is the streamlining of a healthcare system’s reimbursement cycle. It ensures that healthcare providers like physicians get timely payments for their services.
Many people consider medical billing & coding as the same thing. However, this is not true because both are two different, but closely-related practices. However, both practices come under one profession: medical billing and medical coding. Let’s go through these practices one by one.
Medical Coding
It is also known as medical classification and is very similar to translation. In this practice, the medical coder converts the patient data and health information into a medical, universal, alphanumeric code. Moreover, this practice also involves converting the equipment, medical services, procedures, and diagnosis. Experts get data from lab results, physician’s notes, patient records, etc. Then, medical billers transform this data into an accurate code that the insurance company can easily interpret.
Every medical procedure and diagnosis has its unique medical code. Therefore, you can understand that medical codes must be in thousands. Moreover, each will be for a different service or procedure, injury or illness. Different visits (outpatient, inpatient, etc.) will have different codes. Moreover, there are also unique codes for a patient’s symptoms, tests performed, the diagnosis, etc. These codes are like a universal language for medical facilities, clinicians, government agencies, insurance companies, and other healthcare organizations.
There are different coding classification programs, like HCPCS Level II, ICD-10-CM, and CPT. After determining and confirming codes for accuracy, the medical billing and coding expert enters them into the system. These codes assist healthcare professionals to bill correctly, ensuring profit efficiency.
Medical Billing
This practice is almost what its name suggests. A medical biller takes the medical codes and prepares the health insurance company bill against it. These bills are known as insurance claims. The procedure of submitting an insurance claim to the relevant insurance company is known as medical billing. After correct submission of the insurance claim, the healthcare provider gets compensation for their service.
Moreover, a medical biller is also responsible to follow up on health insurance claims. It is essential to ensure that the healthcare provider receives the reimbursement. Therefore, medical billing becomes a critical component of modern-day healthcare facilities. Additionally, it helps in safeguarding and optimizing revenues.
Summary
It is essential to understand that medical billing and coding are two different entities. However, their common objective is to help healthcare providers get reimbursements for their services. Getting an appointment from a doctor may seem an easy 1-to-1 encounter. However, getting paid for that appointment involves several processes and parties. This is where a billing and coding expert play a great role.
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