Medical billing and coding are important aspects of any healthcare organizations. They ensure the smooth flow of funds in such organizations. Medical coding is done prior to medical billing.
What is Medical Coding?
It is a way of summarizing a patient’s report in the form of standard codes (numbers and letters). Every service rendered by healthcare providers has codes attached to them. It is the duty of a medical coder to translate them into codes for further processing by the medical biller.
Let us say, for example, a patient visits a hospital to see her doctor. She complains of cough, fever, night sweats and suspected weight loss. The doctor weighs the symptoms, examines her, runs some test on her, finds out she is suffering from tuberculosis, notes down recommendations and, prescribes some drugs. These procedures (consultation, diagnosis, recommendation and prescription) are filed in the patient’s records.
Afterwards, a medical coders takes up the records and translates the procedure into codes specific for each procedure. These codes are then entered into forms or software programs as information for use by medical billing.
Types of Medical Codes
Medical codes are like shorthand used by medical experts and health insurance companies for effective communication. They are numerous, running into thousands. Let us break them down a little.
1. ICD codes: It is the International Classification of Disease codes. It covers codes used to denote sicknesses and injuries.
2. CPT codes: It is the Current Procedure Terminology codes. It covers codes used to denote services rendered by the healthcare provider to or for the patients.
3. HCPCS codes: It is the Healthcare Common Procedure Coding System. It is a set of codes not covered by the CPT code.
What is Medical Billing?
It involves the submission of bills (called claims) to health insurance companies to receive payment for services rendered by healthcare professionals. To achieve this, a medical biller needs to decode the information sent by the medical coder, and create bills from the decoded information. This means biller must be knowledgeable in the different types of codes used in the healthcare industry.
After bills are sent out, the insurance company evaluates and returns the bill to the medical biller. The payment made by this company will depend on the insurance coverage of the patient. In case partial payment is made by the company, the medical biller gets the remaining payment from the patient.
If the patient we used as an example has insurance coverage for infections related to tuberculosis, most of the payment will be given by her insurance company.
In instances claims are delayed or rejected by the insurance companies, the medical billing company follows up, revises and re-submits the claims until they are approved. A medical biller can also hire a collection agency if the patients have no present means of payment.
Medical billing takes care of the financial aspect of healthcare services. It ensures that providers are effectively paid for services rendered. A medical billing serves as a link or intermediary between the patients, healthcare providers and health insurance companies.