WHAT IS MEDICAL BILLING AND CODING?



Medical billing and coding are two closely related aspects of the modern health care industry. Both practices are involved in the immensely important reimbursement cycle, which ensures that health care providers are paid for the services they perform.



For the sake of simplicity, let’s divide the two at the moment and look at them as separate pieces of a larger process.



We’ll begin with medical coding.



Is Medical Coding the same as Medical Billing?



The main task of a medical coder is to review clinical statements and assign standard codes using CPT®, ICD-10-CM, and HCPCS Level II classification systems. Medical billers, on the other hand, process and follow up on claims sent to health insurance companies for reimbursement of services rendered by a healthcare provider. The medical coder and medical biller may be the same person or may work with each other to ensure invoices are paid properly. To help promote a smooth coding and billing process, the coder checks the patient’s medical record (i.e., the transcription of the doctor’s notes, ordered laboratory tests, requested imaging studies, and other sources) to verify the work that was done. Both work together to avoid insurance payment denials.



The medical coder and biller process a variety of physician services and claims on a daily basis. Medical codes must tell the whole story of the patient's encounter with the physician and must be as specific as possible in regards to capturing reimbursement for rendered services. To better understand what a coding transaction looks like, read the article "What Does a Medical Coder Do?"



Education and training is key to becoming a skilled and successful medical coder. The first step coders must take is to have a thorough knowledge of anatomy and medical terminology. It's also important to become familiar with the codebook resources CPT®, HCPCS Level II, and ICD-10-CM and their coding systems. It's also vital to know the coding systems' corresponding guidelines and what codes are accepted by which insurance plans, which government and payer regulations to follow, and how to be compliant while coding.



Besides assigning CPT®, ICD-10-CM, and HCPCS Level II codes correctly to claims, coders may also audit and re-file appeals of denied claims. They may step into the role of educator to providers and recommend the appropriate codes that follow federal mandates and compliance. When coders are auditors as well, they will require providers to use specific coding and billing standards through chart audits. They may also speak on behalf of the provider and patient on coverage and medical necessity issues. The standard medical coding professional obtains the Certified Professional Coder (CPC®) credential. The good news is coding-related jobs are expanding due to the growing landscape of the business side of healthcare. For example, Certified Professional Medical Auditor (CPMA®), Certified Professional Compliance Officer (CPCO™), and Certified Physician Practice Manager (CPPM®), etc., are areas that coders can branch into.



WHY WE CODE:



Let’s start with a simple question about medical coding: Why do we code medical reports? Wouldn’t it be enough to list the symptoms, diagnoses, and procedures, send them to an insurance company, and wait to hear which services will be reimbursed?



To answer that, we have to look at the massive amount of data that every patient visit entails. If you go into the doctor with a sore throat, and present the doctor with symptoms like a fever, sore throat, and enlarged lymph nodes, these will be recorded, along with the procedures the doctor performs and the medicine the doctor prescribes.



In a straightforward case like this, the doctor will only officially report his diagnosis, but that still means the portion of that report that will be coded contains a diagnosis, a procedure, and a prescription.



Take a step back, and this is suddenly a lot of very specific information. And that’s just for a relatively simple doctor’s visit. What happens when a patient comes into the doctor with a complicated injury or sickness, like an ocular impairment related to their Type-2 diabetes? As injuries, conditions, and illnesses get more complex, the amount of data that needs to be conveyed to insurance companies increases significantly.



5 Reasons to Become a Medical Biller or Coder:



1. Work from Home:



A growing number of health care providers are choosing to outsource their medical coding workload. For fully trained specialists, this trend provides the opportunity to build thriving, at-home businesses.



2. Start a Business with Low Overhead:



In addition to education and training, specialists can establish their at-home businesses with only a computer, a reliable medical coding and billing software program, and a list of potential clients.



3. Get Educated Online:



To compete in these professions, specialists must invest in proper education. Many medical billing schools offer convenient, online courses, along with job placement assistance. Those considering online training should carefully research the options to ensure a proper fit with their schedule and educational needs.



4. Complete Your Education Quickly:



Completing coursework can take as little as two or three months, depending on the school. Many medical coding schools offer degree programs that students can complete in two to four years. Beyond education, certification gives medical billing and coding specialists the edge in getting jobs and in earning potential.



5. Provide a Service to Health Providers:



Medical coding specialists see to it that health care providers get paid for their services. At the same time, they serve as patient advocates in settling accounts and helping to decipher the complexities surrounding insurance claims. In this regard, you help both the patient and the professional optimize the insurance benefit.



Medical billing and coding professionals are also responsible for investigating rejected or denied claims. There’s an important difference between a rejected claim and a denied one: A rejected claim is found to have one or more errors before being processed and can thus be corrected and resubmitted.



A denied claim, on the other hand, is a claim which has already been processed but has been denied by the paying party – for example, an insurance company may deny a claim because it violates their agreement with the patient.



In both cases, a medical biller and coder must examine the claim in question and work to resolve the issue as quickly as possible. They can accomplish this by performing a thorough audit of the claim in question, and correcting any mistakes or discrepancies that they find.



What is Medical Billing:



A vital process in the perpetual functioning of any hospital or medical office is medical billing. Medical billing involves preparing billing claims and submitting them to insurance providers. This ensures that the hospital or medical office is reimbursed the correct amount for the services that they provide patients.



Medical offices receive money from private insurances providers and various healthcare programs, such as Medicare and Medicaid, which are provided by the government. Receiving proper funds allows the medical office to stay open. With suboptimal reimbursement, it is difficult for them to provide stellar healthcare to patients.



How Much Do Medical Coders Earn?



A medical coding professional’s earning potential varies depending on many factors. Where they live, how much they work, education, experience, specialization, and certifications all play a role in determining wages. AAPC’s annual salary survey will give you insight into medical coding salary trends. Employers and employees already in the healthcare business industry can rely on AAPC's Salary Survey Calculator to input specific parameters and determine what others in comparable situations are earning. You can also visit our medical coding training or certification pages to learn more about a career in medical coding.





Medical billing and coding certificate:



there many website where you can get your medical billing and coding certificate

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6- www.branfordhall-us.com click here for sign up

7- www.ignite.fortis.edu click here for sing up

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