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Tag Archives: Medical Billing

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How Does Medical Billing Differ From Coding?

Although there are similarities between the two, medical coding and billing are in fact two separate processes. Contrary to common belief by people, they are not one and the same. In both the processes, professionals happen to work in health care setting, gather health information from the patients, and confer with physicians and insurance companies. The similarity ends here.

Fundamental Functions of Medical Coders

Medical coders are entrusted with the determination of the procedures that have been performed by the physician, surgeon, or other member of the health care team. They then assign the diagnosis code or proper procedure code for the corresponding services provided by the medical professionals to the patient.

Medical coders make use of Current Procedural Terminology (CPT) for allocating codes related to procedures received by patients; they refer to International Classification of Diseases (ICD) for choosing the diagnosis code for labeling the concerned physician’s diagnosis about patient’s condition. Coders are expected to assign perfect codes as these will be used as base by insurance providers toward patients’ insurance claims.

What do the Medical Billers do?

Medical billing involves entering codes into specific software and then processing insurance claims. Medical billers use special billing software that lets them enter the codes that are assigned by coder as well as other relevant information- facilitating sending the claim to insurance company for payment.

Entrusted with the process of dealing with insurance providers, medical billers are expected to have complete knowledge of the claims process and all requirements that need to be submitted for processing claims. The responsibility of handing proper insurance claims lies with them too. In this connection, they must ensure that correct billing format is followed, all fields have been answered properly, and all supporting documents are included in the file.

Distinct Processes in Medical Coding

It is the medical coder’s responsibility to decipher documentation of patients’ interaction with care providers such as physicians, surgeons, or nurses – they determine appropriate diagnosis and procedure codes for reflecting the services provided.

Exclusive Tasks in Medical Billing

Medical biller takes the assigned codes along with necessary insurance data, inputs them into the specific billing software, and submits claim to the payer (which is mostly an insurance company) for payment. Moreover, billers need to follow up on the claim as and when required.

To put it shortly, medical coders and billers are entrusted with the task of collecting information, coding claims, and arranging payment for physicians in timely manner. Both these roles are crucial for practice cash flow.

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The Importance of Medical Coding Compliance

Setting up and running a medical practice is no easy task. Young medical professionals who aspire to set up their own practices need to understand the fact that it may even take months to complete and there will always be regular changes in legislation and regulation that must be properly adopted

Change-adoption is Vital in Running Medical practices

Similar to other modern industries, medical industry is almost always under evolution. Innovative and unprecedented changes keep occurring in the medical field, necessitating practitioners to adhere to the latest legal and regulatory needs. Practices must be able to adopt such changes quickly and meaningfully.

Major changes in health care industry such as ICD-10 are normally announced well in advance, giving sufficient time for enactment. It is crucial on the part of physicians to get ready for these changes and start preparations early. It is through proper assessment of how well the practice will handle the medical coding changes that physicians and practices may be able to position themselves for prolonged success in future. Understanding the benefits of changes and taking necessary action to adopt are key in effectively running the practice.

Benefits of Complete Compliance to Medical Coding

  • Practice Revenue can be Optimized
    • Medical coding being a vital step in the process of medical billing process, care needs to be exercised in performing this task – inaccurate or untimely coding will lead to delayed claim submission, denied or reduced payment, and sometimes, complete loss of revenue – whereas accurate coding helps facilitate the revenue stream
  • Compliance Risk is Reduced
    • By adopting to changes promptly, it is possible to avoid financial penalties that result out of non-compliance – by delegating medical coding and billing tasks to reliable third-party service providers, medical practices may be able to adhere to coding regulation
  • Practice can be assessed
    • Having experienced and professional coders manage your coding and billing needs ensures that your practice will be properly trained in the changed medical coding environment

Numinatrans has been providing medical billing and coding services to health care facilities spread across the globe. Our expert billers and coders ensure that all regulatory requirements are met. We help your practice to accomplish improved reimbursements through accurate coding and billing processes.