What is the Process Behind Medical Billing and Coding?

by | Apr 30, 2019 | Healthcare

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Medical billing is a huge industry that supports the health care system. Those who work as medical coders have a very important job. Everyday, these coders have to review the work of doctors and staff to assign certain codes. These codes determine how the hospital will bill the client, or insurance companies. They also help the medical staff keep a history of treatment, and plan further care. In some cases, the coding team may use an evaluation and management coding tool. Find out more about how medical coders work in the real world.

More About the Role

When medical billing consists of submitting claims to get payments for healthcare services. However, before a claim can be submitted, one has to know how to make sense of the coding system. This involves being familiar with medical records and the applicable codes. There are several code systems that are used for this purpose. These include HCPCS, CPT and ICD-10-CM. Each one of the numbers in these coding systems translate into a type of medical service. A medical claim must be correct in order for insurance companies to pay on it. Thus, it is a very detail-oriented field.

Medical coders can play different roles in the billing agency. Some may handle the follow-up process with the insurance agency. Others may work on the entry of charges and transmitting the claims. Still, others work with the patients themselves to ensure that the claims are satisfied. Medical coders are often trained in many areas of the job.

A Close Look at One Code

To explain medical billing better, it is easier to look at a code system. ICD-10 codes are used for various diagnoses of medical conditions. Under this system, there are two different parts. One is the procedure coding system for inpatient services. The other is the clinical modification for diagnostic purposes. All in all, there are tens of thousands of code that can be used. An evaluation and management coding tool can help with this process. In the end, all the codes help in some way to show why medical services were received and the level of assistance.

For more information on evaluation and management coding tool, contact Gebbs Healthcare Solutions through their website today.

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