Medical billing and coding are two closely related aspects of the modern health care industry. Both practices are involved in the immensely important reimbursement cycle, which ensures that health care providers are paid for the services they perform. When a patient has any medical exam or procedure, the medical office will work with the patient and the patient's insurance company for claims. The biller will submit and follow up on any claims in order to receive payment for services rendered by the health care provider. This usually involves learning many codes, each one representing a symptom, medications and diagnoses, in order to process the claim properly. Medical billing and coding workers are the health care professionals in charge of processing patient data such as treatment records and related insurance information. Medical insurance billers and coders are tasked with coding a patient's diagnosis along with a request for payments from the patient's insurance company.
Medical coding, at it's most basic, is a little like translation. It's the coder's job to take something that's written one way.
For example -: A patient walks into a doctor's office with a hacking cough, high production of mucus or sputum, and a fever. A nurse asks the patient their symptoms and performs some initial tests, and then the doctor examines the patient and diagnoses bronchitis. The doctor then prescribes medication to the patient.
Every part of this visit is recorded by the doctor or someone in the healthcare provider's office. It's the medical coder's job to translate every bit of relevant information in that patient's visit into numeric and alphanumeric codes, which can then be used in the billing process. The coding process ends when the medical coder enters the appropriate codes into a form or software program. Once the report is coded, it's passed on to the medical biller.
On one level, medical billing is as simple as it sounds: medical billers take the information from the medical coder and make a bill for the insurance company, called a claim. Of course, as with everything related to the health care system, this process isn't as simple as it seems.
Let's take an example-: Our same patient has a cough, a fever, and is producing lots of mucus. This patient calls the doctor and schedules an appointment. It's here that the medical billing process begins. The medical biller takes the codes, which show what kind of visit this is, what symptoms the patient shows, what the doctor's diagnosis is, and what the doctor prescribes, and creates a claim out of these using a form or a type of software. The biller then sends this claim to the insurance company, which evaluates and returns it. The biller then evaluates this returned claim and figures out how much of the bill the patient owes, after the insurance is taken out.
The biller has a number of other responsibilities, but for now you should simply know that the biller is in charge of making sure the healthcare provider is properly reimbursed for their services.
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