05
July
- Delisa M
- Comments 0
Medical Billing and Coding
Medical billing and coding is the process of follow and submit claims, medical billers and coders are also called health claim specialist. They process health insurance claims of doctors, hospitals and other healthcare service providers. They are responsible for coding and to maintain patient’s information correctly in Electronic Health Record (EHR).
To do all these tasks few individuals are required:
Office Administrator
Receptionist
Medical Billers
Medical coders
The medical billing process starts when patient ask for appointment with physician. From here, the receptionist or front desk staff collects patient information, which includes
Name:
Address:
Date of Birth:
Contact Number:
Reason for Visit:
Insurance Provider:
Policy Number:
It is important to enter the above information correctly into the EHR system. Any data entered wrong may be a cause for a denial or rejected claim in the future.
The patient’s insurance coverage should be verified by the office administrator, after updating the initial information. It also identifies the list of patient’s current insurance policy. The administrator also updates the other medical billing procedures required by a provider. Once these things done, administrator should inform the patient if he or she needs to pay.
All the information related to patient should be recorded and placed in the medical record. This is all done by medical coders, they translate all the diagnoses and medical procedures into medical codes. Medical coders diagnose the treatment that has been administered to the patient, translating into ICD or CPT codes.
Now the billers transmit the medical claim to the insurance provider, after the diagnoses and treatment coding done. This also needs to be viewed internally, before submitted to insurance company. This ensures all data has been accurately entered electronically into provider’s system.
After receiving the claim by the insurers, it is evaluated and reviewed. The insurer determines if the entire or just a portion of the bill should be paid, or if it should be denied. This all depends on the policy and the contract signed by the patient to the insurer.
Due to some reasons the patient needs to pay for the remaining bill not covered by the provider. This is why some insurers and healthcare providers implement a co-payment policy. It is the responsibility of healthcare provider to follow up with the patient for collection process, if the patient fails to pay the bill accordingly.