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The Importance Of Medical Billing And Coding

May 15, 2014

Although it is in the professions name, some are not aware that a medical billing and coding professional, is actually to separate jobs in one. Many offices hire either one or the other, but there are those who hire one person to perform both jobs. It is usually a smaller office, with out as much patient flow, as say, a larger hospital, with many patients being seen on a daily basis.

A medical biller, would be one who would take the information that the medical coder had already provided, regarding diagnosis’s and procedures, and input those codes to an electronic insurance claim form to be sent via internet, for a speedy return of reimbursement. Knowing what each insurance company expects on their submissions can be tricky when first learning the process, and to a degree there may be a bit of trial and error, initially. Once a system is established, the process is usually error proof, but it does take experience.

The medical coder is one who would analyze and decipher, from the physicians notes, what codes would need to be used in order for the maximum medical reimbursement return, for the services in which the physician has provided to the patient. The job usually involves a great deal of research and analysis.

What Are CPT Codes

For those of us who work in the medical billing & coding career field, we know how important it is to use the correct CPT codes, when working with insurance forms. The definition of a CPT code is, Current Procedural Terminology, which is the standard name described and authorized by the American Medical Association, to consistently classify and recognize medical procedures.

The five alpha numeric characters that indicate an exact procedure performed by healthcare professionals. Every year, in January and sometimes in July, the American Medical Association (AMA) is responsible for updating the coding standards and obliterating the codes that are non-existent. Most medical offices are on the lookout, for the updates, come, January. To not be prepared, could mean delays in insurance reimbursements, and possibly denials, due to wrongful coding.

Modifiers

There are also modifiers to CPT codes, that are available to the medical coder, as they allow additional information to be added to the original procedure, in order to better explain what the physician has performed. With these added use of addendum’s in some processes, allows the elimination of fewer errors in the billing process, and in turn grants speedier payments.

The bottom line is that the outcome of both jobs, either the medical biller or the medical coders, are equally a great benefit to the offices who employ these highly skilled professionals.