What is Medical Billing and Coding? Explore the Fundamentals of Medical Billing and Coding
Medical billing and coding is the process of identifying diagnoses, medical tests, treatments, and procedures found in clinical documentation, coding the data into standardized medical codes and submitting them to payers for reimbursement for the services rendered. In this article, we will explore this further.
WHAT IS MEDICAL CODING?
When a patient encounter occurs, providers provide all the necessary information such as diagnoses, procedures and other services rendered in a medical record. Medical coding services is the process in which medical coders review clinical documentation, extract billable information and translate them into standardized codes.
Uniformity in codes allows diagnoses and treatment information to be more easily understood by medical practitioners, insurers, third-party party agencies that track health data and researchers analyzing medical trends.
TYPES OF MEDICAL CODING
There are many different types of code sets that are used to process healthcare services such as the International Classification of Diseases (ICD) codes to describe a patient’s condition; CPT codes to describe procedures; and HCPCS codes to describe non-physician services such as medical equipment. There are also charge capture codes, professional codes and facility codes.
WHAT IS MEDICAL BILLING?
Medical billing is the process generating healthcare claims to submit to insurance companies or payers to obtain reimbursement for the services provide by healthcare providers and provider organizations. Medical billing is done at the front– end and back-end.
- FRONT END MEDICAL BILLING
Front-end medical billing services is typically the pre-registration and registration process. Patients are required to provide their personal information, including insurance coverage, at the front-desk. Once coverage is verified, administrative staff typically confirms patient’s financial responsibility, i.e. the costs that the patient is responsible for. Once services are provided and the documentation is complete, the medical coding team will perform its job.
- BACK END MEDICAL BILLING
Back-end medical billing services includes generating claims and transmitting them to payers. After the coding is completed, medical billers will prepare a claim, ensure that all the codes are accurate and all patient information is complete and correct. They will then submit the claims directly to the payer or through a clearinghouse. Once the claim reaches the payer, they will review the claim and will either accept, deny or reject the claim. Depending on the reason for denial or rejection, the billers will correct the claim and resubmit them for reimbursement. Ultimately, back-end medical billing services comes down to collections. Payments are tracked and posted to ensure accurate reimbursement is received. If there is an aging accounts receivable, the billers will keep following up till payment is received.
3Gen Consulting is one of the leading medical billing and coding outsourcing companies which provides access to cost-effective solutions and improves your chances of accurate claims submissions. They have a team who are highly trained and aware of the changes in the industry thereby keeping you updated with the latest billing processes and ensures that you comply with the ever-changing regulations.
They follow a customer first approach and customize their services according to the needs of clients. By improving clean claim rate, reducing denials, increasing cash flow, and focusing on your organization’s financial health as a whole, they allow you to focus on patients’ health.
