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Outpatient Insurance Coding - Critical Thinking Ch 5 #8

8. Why would the medical billing specialist need to use HCPCS codes for patients other than those covered by Medicare?

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Medical billers take the medical coder's information and make a bill for the insurance company, called a claim.

# Medical billing example :

- The medical biller takes the codes; the biller then sends this claim to the insurance company, evaluating and returning it.

Therefore, the medical biller acts as a type of spot between patients, healthcare providers, and insurance companies.

- Medical billing specialists use HCPCS codes for patients to represent Medical procedures to Medicare, Medicaid, and several other third-party payers.

- The Healthcare Common Procedure Coding System (HCPCS) is a set of health care procedure codes based on the American Medical Association's Current Procedural Terminology (CPT).

- Healthcare Common Procedure Coding System (HCPCS) was developed by the Centers for Medicare for reporting medical procedures and services.

The correct HCPCS code plays an essential role in patient access to new and existing technologies.


answered by: Bister
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