The two most important components to any medical practice are medical billing and coding. Both require skilled professionals with specific skills in tracking down, reading, interpreting, and recording complex, sensitive medical information while keeping all patient files confidential. Read more to find out why medical billing and coding are so vital to modern medicine.
Medical coding is an important step that is required when a patient is going to submit insurance claims or to receive, pay, and send bills, to patients and their insurer. The coding process involves translating the diagnoses, procedures, treatment(s), medication(s), and equipment into alphanumeric codes. The information comes from a variety of sources, like transcriptions, medical notes, electronic records, and lab results.
Once translated, the codes are transferred to medical billing systems and patient records. Coding directly affects the medical care a patient relating to the reimbursement provided them through their insurance provider. When the correct coding is properly translated and transferred to the right patient files, insurers will be able to disburse the right amount of payment for medical care. Lastly, coding is vital for assessing demographics and maintaining accountability in reimbursement systems.
Compliance with Regulations and Contracts
Today, fee-for-service is becoming increasingly popular, creating a medical environment where physicians are required to list all the preconditions, underlying conditions, and untreated diagnoses their patients have or might develop in the future. At the same time, hospitals and private medical practices are increasingly outsourcing to medical billing and coding services online. This helps doctors and other medical staff focus more on taking care of the patient.
Medical billing and coding fall under several state and federal guidelines. Probably the most significant guideline is the Health Insurance Portability and Accountability Act (HIPAA), which protects patient confidentiality by requiring all hospitals and medical practices to protect sensitive patient data using specific safeguards. Medical practitioners have ironclad contracts with insurance companies that can include crystal clear instructions regarding rates for an array of medical procedures and treatments negotiated by the patient, doctor and insurer(s). Coding and billing services help make sure that practices and insurers comply with these contracts.
Ensuring Regular Payments
Medical billing is important to ensuring a smooth revenue cycle. Medical billers need to be able to understand different regulations as well as the different policies of private and public insurance plans. They learn specialized knowledge about following up with and resolving denials of insurance claims, postings and adjustments of payments, and managing bill collection. Medical billing and coding services help manage these processes, which reduces coding and filing errors, lowers costs to hospitals, practices, and insurance companies, and improves cash flow to patients.