Medical coding and billing is a field in healthcare industry, where an individual need not spend years learning in school and yet master his skills in it. You will find them in various healthcare settings such as: doctors’ dispensaries, private or public hospitals, dental practices, pharmacies, laboratories, etc. Playing a significant part in the healthcare industry you will also find Medical coding and billing specialists running their own business. Medical coders ensure exact analysis of patient diagnosis as well as about its procedures whereas medical billers ensure that insurance agencies, providers of workers’ compensation, Medicare and Medicaid timely receive patient reimbursement forms. You will find many of them skilled in both areas as medical coding and billing.
Also referred as medical analysis is a process where for medical procedures and diagnosis specify its universal codes in alphanumeric or numeric form. Medical coders refer to patient’s medical record available in department, lab technology reports as well as doctor’s report for determination of procedures and diagnosis to be coded. Coders track down details of injuries or diseases and procedures adopted for the treatment given to patients. Medical codes are used on reimbursement claim forms to be submitted to insurance agencies, on diagnostic request forms and Medicare and Medicaid for payment of claims. It is also used for internal facilities for healthcare service provider for the purpose of research as well as marketing.
Medical billing is a process handled by medical billing specialist who represents claims to health insurance agencies to confirm reimbursement to a patient for the services provided by a healthcare service provider. They also follow up and deal with problematic issues of patients on unpaid claims with insurance agencies, Medicare and Medicaid. Medical billing process remains same regardless of whether the insurance agency is privately owned or is owned by the government.
Qualifications of medical billing and coding specialist
In the healthcare industry the profession of medical coding and billing specialists is heavily in demand. Medical billing specialists with a Bachelor’s degree in health information management or equivalent are placed higher at management positions, though they may not possess substantial practical knowledge or experience. You will also find the medical coding and billing specialists who possess a relevant diploma course or a certificate.
It is essential for a medical billing specialist to have detail knowledge and understanding of HIPPA an abbreviation of Health Insurance Portability and Accountability Act for which they also receive training. The act protects patient health information privacy whether it is in spoken, written or in electronic form and can adversely affect many levels working in the healthcare industry.