The Process of Medical Billing and Coding

Healthcare providers are very important to everyone. They are the

ones people go to when they have health problems, injuries or if

they need medication. They also help patients in maintaining their

health and prevent diseases. Patients usually have medical insurance,

which they use for their hospitalization or treatment. The insurance

provider will then pay the healthcare providers on everything that's

under their coverage. The billing process is a long one. It usually

takes several weeks or even months before it gets settled. This can

be very inconvenient to healthcare providers if they take care of the

process on their own, as they are busy with their work. This is why

they hire medical billers and coders to do their billing and coding.

Healthcare providers can hire a medical biller to do the billing and a

medical billing and coding jobs to do the coding. Sometimes, they

hire only one person to do both medical billing and coding, though this person is paid higher

since he has more responsibilities. The medical coder is responsible for translating the details of

the patient's medical record into medical codes. The details include the diagnosis, treatments and

procedures made during the hospitalization. The coder use standard codes from two manuals.

The ICD-9 or International Classifications manual is for coding diagnoses and the CPT or

Current Procedural Terminology is used for coding procedures.

More information can be found here.

The medical biller will then send the billing to the patient's

insurance provider. Sometimes, patient has corresponding amount

that they need to pay. For instance, if they have deductibles or

coinsurance, the amount will be deducted to the total bill. The

medical biller will also send a billing to the patient with the

corresponding amount that they need to pay. It's also their responsibility to explain to the patients

what the bill is for, if ever they have questions. They can also negotiate on the terms of payment

as well as the collection.

Some hospitals use a program for automatic billing. The program will read the medical billing

jobs and input the necessary codes. However, a medical coder would still usually double-check

them for errors. Billing and coding should be done accurately to get the payment faster. If there

are any errors, the insurance provider may reject or deny the request, which usually includes an

explanation on why it's denied or rejected. If there are problems with the codes, the coder must

make necessary corrections. If there are errors on the charges, the biller must make proper

adjustments then send it back to the insurance provider until its approved and paid.