Thursday, November 21, 2013

Learn about Medical coding and billing

Medical coding:

Suppose a patient has been given medical services from a physician's office or healthcare facility. Now the medical coder needs to take note of the abstract of the services the patient was given. He has to examine all the relevant documents and make a gist out of them. Then he assigns appropriate codes to it and makes a claim for payment. The person who is paying may be an insurance company, any organization or the patient himself.
Jobs done in Medical Coding: Generally a medical coder works in the office reviewing, assessing, processing and submitting medical claims. He may have to visit the physician or diagnostic section of the hospital to acquire more knowledge of the service usage of a patient. Medical coders also need to apply codes viz. CPT®, HCPCS Level II and ICD-9-CM codes to record the services used and the resources required to treat him by the physician. These codes are like bible to medical coders. Without proper coding, it is impossible to record all the diagnosis done on the patient and complete the record concerning the patient's illness.

Skills required for medical coding:

1)Need to know several medical terms and should have an apparent knowledge on human health and anatomy.
2)Need to know all the codes and guidelines on how to use them.
3)Need to know how to audit and reapply for rejected claims.
4)Should feel easy working with numbers.
5)Should collect data from every nook and corner of the facility wherever and whenever possible.
6)Should be able to review and assess files quickly.

Medical Billing:-

Same story. A patient has been given medical services from a physician's office or healthcare facility. Now after the patient took the service, it is the responsibility of the medical facility to make a note of the services and map it into a billing claim. This process is known as medical billing. Now it is the duty of the medical biller of the organization to present the bill to the insurance company for the reimbursement.
Jobs done in medical billing: - The role of a medical biller of an organization is to present the bill to the insurance company for reimbursement. His job size can vary with the amount of work related with it. He has to collect all relevant information from everywhere in the organization to make the claim perfect. He has to collect and add various data like charge entry, claims transmission, payment posting, insurance follow-up and patient follow-up. He has to communicate with the physician and other professionals of the organization to keep himself updated with the current information. So a medical biller needs to know how to read medical records. He should also be aware of codes like CPT®, HCPCS Level II and ICD-9-CM codes because sometimes if there is no medical coder, he might have to apply the codes himself.

Skills required for medical billing:

1)Knowledge about different types of insurance rules and guidelines.
2)Knowledge about insurance companies and their claim requirements.
3)Effort to collect compensation for rejected claims.
4)Maintaining all the related regulations in terms of clean claims, timely filing guideline, fair debt collection practice, refund requirements etc.
5)Use raw data to improve on various sectors if needed.
6)Marinating good public relations.

Are there any difference between medical billing and coding?

Although the job for both medical billing and coding sound similar, there are differences between them. The job of a medical coder is very diverse. He has to gather all kinds of reports about the patient from anywhere he can get. For that he must look into the patient's medical records, prescriptions by the physicians, tests done for him, image studies etc. Then after gathering all these, he must apply the standard codes to the reports and procedures applied on the patient and supply the medical biller with the necessary information.
Now the medical biller comes into the play. He, getting all the relevant information form the medical coder, proceeds to make a bill. This bill comprises of all the relevant and necessary reports on the expenditures made for the particular patients. This bill is then sent to claim the money either from the patient himself or from an insurance company for reimbursement.
This is true that their works are very much inter-dependant and that is why sometimes a single employee plays both the roles in an organization or hospital. If not, both the employees have to work very closely.

Final Judgement:

Medical industry is a growth industry. Need for expert people in medical billing and coding is high. So one can select this option for a good career. There is no fear of recession in this industry. Plus the job satisfaction and salary is quite high here. So take a leap into medical billing and coding industry and have fun.