Medical Billing And Coding
What Is Medical Billing And Coding?
Medical billing and coding is the system of billing and collecting payments for health services rendered. The medical biller works with the health care provider, patient and insurance company to assure all billable charges are billed to the proper entity, and the health provider is paid for services performed. Medical coding and billing is a very important aspect of the health industry.
The medical billing process is the interfacing of the health care provider and an insurance company by the medical coding and billing professional. The billing cycle can take anywhere between several days and several months to complete. If the claim is denied by the insurance company, it may take several the interactions between the biller and the insurance company before the problem is resolved and the health care provider is paid for services performed. If the claim is denied and there is no resolution, the patient will be required to pay the bill.
The Medical Billing Process
The patient medical coding and billing process begins with appointment number one, either a trip to the doctor or the emergency room. The medical record that is established for the patient follows that patient until the claim is complete and the file is closed. That record will contain a summary of the treatment, as well as the demographic information for that patient.
The information will include name and contact information and the insurance policy identification number, which is found on the patient’s health care card. If the patient is a minor, then the information of the parent or guardian or other guarantor will be added to the patient’s record, as well.
The file will often contain one or more diagnosis to better coordinate and streamline their care. If there is no diagnosis, the reason for the doctor or emergency room visit will be noted in the file. Information for all doctor visits, medication prescribed, examination details and suggested treatments are all included in the patient file which is forwarded to the medical coding and billing professional for the billing process.
The complexity of the medical decision and the extent of the physical exam and patient history are evaluated to determine the level of service performed and the level of service billed to the insurance company. The level of performed medical care is translated into a five digit code based on the current procedural terminology database. The verbal diagnosis is translated into the five digit code based on the ICD-9-CM database.
Once the coding has been established, the medical coding and billing professional will process the form in an electronic format and transmit that document to the insurance company for payment. The medical billing and coding system is nearly 100% electronically based.
The insurance company employs medical claims adjusters and investigators for the purpose of evaluating the claim for validity. The rubrics include patient eligibility, medical necessity and provider credentials. Claims that are approved are billed for a percentage of the cost. Those rates are negotiated beforehand between the health care provider and the insurance company.
A claim that is rejected is sent back to the health care provider with an explanation of the rejection and remittance advice. The medical biller will evaluate the reasons for rejection and take the necessary steps to make sure the information submitted is within the frameworks of the insurance coverage.
Medical Billing And Coding School
You will discover numerous approved professional medical billing and coding schools providing training courses in this field. The majority of medical billing and coding schools provide diploma courses which you can complete in 9 to 12 months. Various schools actually offer you daytime and nighttime instructional classes, therefore you can work full-time whilst getting the training you’ll need. Take a look at our tips about choosing the best university for you.
Training options differ, however, most medical coding and billing school courses will certainly educate you good clerical, organizational, customer service and people skills to get you ready for even the biggest challenges of the occupation. Courses in biology, typing, bookkeeping, mathematics, health, computer systems and office administration will definitely assist to lead the way to succeed in medical billing and coding. For more information about certifications visit the National Healthcareer Association (NHA).
Medical Billing And Coding Salary
This field is ever growing with lots of job opportunities. The high demand for specialists enables them to to make a good income. Although the salary is not extremely high, it will allow you to lead a great lifestyle. Actually the salary for this occupation is significantly impacted by numerous aspects including geographic area, experience, where you work, specialty as well as degree of education.
A medical billing and coding salary will differ from location to location. Individuals who work in larger metropolitan areas like New York City and Chicago earn considerably more. It is because of the high cost of living and a higher minimum wage in these cities. Medical coding and billing professionals who are employed in big organizations such as nursing homes and big hospitals earn more in comparison to the people who work in the billing department of a small doctor’s office. This difference in the medical billing and coding income is because of the increased responsibilities for those in bigger institutions.