Question

Medical coding and billing is a significance element that benefits; health insurance companies, healthcare providers and institutions, patients, and public health. Explore benefits in these four areas. Word counts should be 300-500.

Answer 1

^Answer:

^{Medical coding is the transformation of healthcare diagnosis, procedures, medical services, and equipment into universal medical alphanumeric codes. The diagnoses and procedure codes are taken from medical record documentation,}

^{Medical billing is the process of submitting and following up on claims with health insurance companies in order to receive payment for services rendered by a healthcare provider. Medical billing translates a healthcare service into a billing claim.}

^{Benefits of medical coding and billing in the health insurance companies, healthcare providers and institutions, patients, and public health are:}

^{Medical coding:}

^{-Through medical coding accurate codes to the claimant's diagnosis, procedures and treatment rendered can be given in a universally understandable language.}

^{-Procedure codes, whether Current Procedure Terminology (CPT) or Healthcare Common Procedure Coding System (HCPCS), tell the payer what service the healthcare provider performed. Diagnosis codes, documented using ICD codes, demonstrate medical necessity. In other words, procedure codes tell what of a patient’s visit, and the diagnosis codes tell the why.}

^{-Medical coding reports what the diagnosis and treatment were, and prices are applied accordingly}

^{-Diagnosis and procedure codes are used to track the spread of disease or the effectiveness of a particular procedure, their main use is in the reimbursement process. In other words, codes helps to bill accurately and efficiently.}

^{-Medical coding helps summarize otherwise cumbersome medical reports into efficient, data-friendly codes. Coders document the condition of a patient and describe the medical procedure performed on that patient in response to their condition.}

^{-The whole story of the patient's encounter with the physician will be coded as specific as possible in regards to capturing reimbursement for rendered services can be known through coding.}

^{-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 relatedness of the treatment rendered to the diagnoses of the patient can be done with the help of medical coding even if the medical records are not available as the codes gives the information regarding disease condition, treatment rendered and equipment used.}

^{-The confidentiality of the claimant can be safeguarded with the help of medical coding as the codes cannot be understandable at a glance by the laymen who do not have any information regarding decoding the provided codes.}

^Billing:

^{-Once the procedure and diagnosis codes are determined, through medical billing, the claim was transmitted to the insurance company (payer).}

^{-Medical billing gives the detailed information regarding the payable services to the patient, providers and also facilities.}

^{-The biller negotiates and arrange for payment between the three parties. Specifically, the biller ensures that the healthcare provider is compensated for their services by billing both patients and payers. Healthcare providers need to be compensated for the services they perform.}

^{-The biller collects all of the information (found in a “superbill”) about the patient and the patient’s procedure, and compiles that into a bill for the insurance company, which is called a claim, and it contains a patient’s demographic information, medical history, and insurance coverage, in addition to a report on what procedures were performed and why.}

^{-The biller adds information about the patient and the patient’s visit, along with the cost of the procedure or procedures performed, to the claim. So the claim now has a what, a why, a who, a when, and a how much.}

^{-The biller also checks to make sure a claim is compliant. That is, the claim is factually and formally correct. The biller must know what the claim allows so that the payer can fully evaluate the procedure and decide how much they will reimburse the provider. If the claim is approved, it’s sent back to the biller with the amount the payer is going to pay. The biller then takes the amount, called the balance, and sends it on to the patient.}

^{-When a patient receives medical services from a healthcare provider, they are typically presented with a bill at the end of their services. The biller creates thar bill by looking at the balance (if any) the patient has, adding the cost of the procedure or service to that balance, deducting the amount covered by insurance, and factoring in a patient’s copay or deductible.}

^{-Billers also work daily with a patient’s medical records. Billers abstract information from patients’ medical records and insurance plans to create accurate medical bills.}

^{-A biller is constantly in communication with insurance payers, clearinghouses, providers, and patients. Since the biller acts as the waypoint for the reimbursement process, they frequently have to clarify and follow-up with all parties of the healthcare process.}

^{-Billers also explain and notify patients of their bill. Billers are in charge of issuing Explanations of Benefits (EOBs) to patients, which list which procedures are covered by the payer and why.}

^{-Billers must also follow up with patients about paying the balance on their medical bills. A medical billing specialist will arrange someone for collections on that debt.}