The Importance of Medical Billing and Coding in Healthcare

The Importance of Medical Billing and Coding in Healthcare

Medical coding and billing is one of the most important parts of the healthcare industry. Coding and billing are used to create accurate patient records and transmit patient visit information to insurance companies for reimbursement. The medical codes use a universally understood system to transcribe wat happened during a patient visit. This information is used to generate bills for the medical office, and claims for the insurance providers. Medical coding has become even more important due to the Affordable Care Act. Healthcare facilities also use the data to determine where to allocate resources for better patient care.

What is Medical Billing and Coding?

Medical billing and coding is a system of processes and techniques for encoding and translating medical diagnoses, treatments, services, and patient visits into a series of universally understood codes. These codes are filed in patient medical records and transmitted to insurance providers and government healthcare programs for reimbursement to the healthcare provider. The adjusted medical bills are sent to the patient for their portion of the payment.

What is Medical Coding?

Medical coding is the process of assigning standardized codes to medical diagnoses, treatments, services, and procedures in a patient visit. These codes are used in electronic health records, and for transmission to insurance companies and government healthcare programs for proper reimbursement to healthcare providers. Medical coders use specialized codes, such as the International Classification of Diseases (ICD-10) to document patient information.

The medical codes are used to properly bill insurance companies, as well as collecting data on trends in treatments, prescriptions, and procedures used to treat patient conditions. This data can be used by healthcare organizations to analyze patient outcomes.

A crucial part of medical coding is making sure patient records have the correct codes for the appropriate diagnosis and treatment. They must be able to interpret the physician’s notes correctly and find the correct code. The coding conventions may periodically change with new versions of the ICD-10, so staying up to date is very important.

What is Medical Billing?

Medical billing is the process of preparing and submitting claims to insurance providers on behalf of a healthcare provider. The medical biller helps ensure the medical facility is reimbursed properly for healthcare services. This is an important role, as without proper reimbursement from health insurance companies and healthcare programs like Medicare and Medicaid, the medical office will not have the revenue stream they require to provide adequate patient care.

The Importance of Medical Coding

 Accurate medical coding ensures healthcare providers receive the correct reimbursement for healthcare services provided to patients. Insurance companies and government healthcare plans use the medical codes to determine reimbursement amounts.

When the medical codes are inaccurate, it can affect the reimbursement rate, delay proper payment, or claims may be denied. Medical coders must also stay up to date with current codes, as they can change when new editions of the code standards are published.

What Happens When the Wrong Medical Codes are Used?

Insurance companies use the number and letter sequences in medical codes to determine whether the procedure or treatment is covered by a patient’s health plan. When the codes are incorrect, payment to the healthcare provider may be delayed or denied.

The codes tell the insurance company what part of the claim is their responsibility and what part of the bill is belongs to the patient. When codes are incorrect, the claim can be denied, meaning the patient responsibility and financial burden is greater for the patient.

ICD-10 Code Guidelines

Working as a medical biller and coder requires that you follow basic coding guidelines. These serve as a sort of best practices guide for each coding system.

When you work as a medical biller and coder, you must follow coding guidelines. The industry standard is the ICD-10.

Examples of current ICD-10 guidelines include:

  • Using a 3-character code only if it is not subdivided
  • Not assigning symptoms routinely associated with a disease an additional code
  • Reporting symptom codes if a definitive diagnosis has not been established

 The Future of Medical Coding

Electronic health records (EHR) are the biggest change that has been made to medical coding and billing in the past decade. EHR systems help automate the collection, storage, and sharing of patient data. Regardless of this, there will still be an invaluable need for well-trained medical coders who can verify accuracy, complete records, and properly encode each part of a patient visit.

 Become a Medical Biller and Coder in About 10 Months

Are you interested in becoming a medical biller or coder? In about 42 weeks, you can become a certified medical biller and coder. Review our online course and industry information to see if Medical Billing and Coding School at Campus is right for you. Fill out an information request form to get started today.

The demand for new medical coders is still strong, and you can work in medical offices, hospitals, specialized physician’s offices, and many of these jobs are remote. Contact an admissions specialist to get more information on this comprehensive training program.