Billing Professionals Basics

Medical coding and billing professionals are highly qualified personnel who convert medical procedure terminology into codes that insurance companies can recognize and establish payment to the medical professionals who performed the work. This work involves an understanding of the anatomy of the body.

Coding professionals are required to have a good understanding of the following:

  • Anatomy
  • Physiology
  • Medical terminology

Coders who have completed medical coding course and passed the CPC exam are in high demand because medical facilities and doctors have confidence in the skills of those who can perform the task of medical coder with the absolute accuracy required to process claims for efficient payment.

The Medical Profession Depends Heavily On Coding Being Done Correctly

The work of inexperienced medical coding and billing personnel will result in the claim being underpaid or not paid at all. Both professions are complicated and require substantial training. More importantly, they require a keen observation of records and doctors’ notes. On October 1, 2014 the U.S. will update the number of codes from 13,600 to more than 144,000 according to the AAPC, which is the nationally recognized certification authority for members of the Billing and Coding profession.

The income of those in the medical profession can be impacted by billers and coders. This is why it is best to have a professional company handle the coding and the billing. The coding must be done correctly or the biller cannot do their job. An experienced coder will know whether to ask more questions to establish the correct code, and they will know whether the information on the procedures is missing vital information that may result in claim rejection.

A Medical Coder’s Task is Always Challenging and Requires a High Level of Expertise

A coder extracts the data from medical records or medical specialists about the procedures performed, and then they assign the appropriate code to the claim. To do this, the coder checks with the doctor, other medical specialists, verifies patient records, and then they assign codes to each procedure. They may have to transcribe the doctor’s notes or the ER room’s records, or any number of other medical procedure records.

The medical coder must make sure that all supplies used are coded and the codes passed on to the biller. An example of a complicated claim is an open-heart surgery that may generate many codes.

The Medical Biller Has to Know the Billing Codes Used by Insurance Companies

Once the codes are established, the work of the biller begins. They understand the different codes that different insurance companies may use for the same procedure. The medical coder and the medical Biller may be the same person or they may work together so that all invoices are paid.

The medical biller’s responsibility is transmitting claims, posting the payments received, following-up with the insurance company, and the patient where necessary. Medical billers must be able to communicate with the coders to clarify diagnoses and to obtain vital information that supports the claim. The medical biller must understand how to read medical records and be familiar with the various levels of codes.

An Organization of Professional Coders and Billers is the Best Option

Considering that the medical coders and billers are the financial lifeline of a medical practice, it would be most important to trust this task to a medical coding and billing company that has a significant degree of experience. The medical office or hospital may never know how much money they are losing because of incompetence in the coding and billing process.