In today’s fast paced world, running a healthcare facility is not an easy task. It requires huge focus on every aspect, be it patient care or revenue cycle management. Patient care can be handled very well by the practitioners, but medical billing and coding needs another level of expertise.
This is where a medical biller and coder takes up the responsibility. A lot of practices prefer to do it on their own but somehow, they are not proficient in it. This might lead to inaccurate coding resulting in claim rejections. Even if they give the responsibility to one person, the proficiency will not be there which will harm the practice in the long run.
We strongly believe that healthcare providers must only focus on providing the best patient care and leave medical billing and coding to the experts. In this blog we will learn about the importance of medical billers and coding in maintaining an efficient revenue cycle management.
Medical Billing & Coding Specialist
The role of a medical billing and coding specialist is to be a mediator between the medical office and insurance company.
A billing and coding specialist helps the healthcare facility to manage invoices, claims and payments. They are responsible for managing the entire billing process by documenting the right codes for the procedures and diagnosis done for the patient.
They prepare and send invoices for claims approvals. If there is any discrepancy or error in the claims it becomes the specialist’s responsibility to rectify and resubmit the claims for approval.
Overall, it becomes the job of a medical billing specialist to track the payments and take follow-ups with the patient and insurance companies about any outstanding bill payments.
A lot of times, healthcare organizations hire people to work as specialists within the organization. However, this seems efficient until your healthcare organization starts getting more patients. Then it will become a huge hassle for you to manage and submit all the claims accurately. That is why partnering with a medical billing company seems more fruitful in the longer run.
Difference Between Medical Coding & Billing
The job role often combines coding and billing within a single position but technically they are two different specialties. It can be handled by one person if it is a small organization or be divided into two individuals for big healthcare organization. Since these are two separate functions one must understand the difference between these two.
What Does a Medical Coder Do?
Medical coding involves taking a proper note of the diagnosis and treatments provided to the patient and converting them into accurate codes for record tracking and billing purposes
The codes are set according to the industry set alpha numeric combinations which are used to identify the services provided to patients.
The coder must be proficient with all the codes such as:
- Current Procedural Terminology (CPT): Used to identify specific procedures and examinations performed
- International Classification of Disease (ICD 10): Codes used for medical diagnoses
- Healthcare Common Procedure Coding System (HCPCS): Codes which are not covered in the above two sets are covered here
Each of these codes play an important part in medical billing and coding. The medical coder needs to follow some strict guidelines for proper billing.
The codes should be entered as soon as the patient makes an appointment. Different codes are applied for the type of visits or symptoms reported by the patient.
Additionally, codes are applied for symptoms observed by the medical staff, treatments provided, diagnoses done, and the tests performed.
What Does a Medical Biller Do?
Once coding is completed, a medical biller generates an invoice of the total expense and sends the claims to the insurance company. Based on these codes, the insurance company can either approve or deny the payment request. If any procedure or treatment is not covered by insurance, it will be sent to the patient.
The billing process begins as soon as the patient makes an appointment. Sometimes if the patient can elaborate their symptoms clearly, the codes are sent to the insurance company for pre-approval.
This helps in predicting the out-of-pocket expense for patient so that they can charge the patient for that amount during their visit. The medical biller also needs to be proficient with all the industry codes even if they are not doing the coding.
The job role of a medical biller includes reviewing the reasons behind any denied claim. They are also responsible for rectifying the mistakes and resubmitting the claims. They verify claims for any discrepancies before submitting the claim.
After the insurance company settles the payment, the remaining balance is invoiced to the patient. Keeping track of the payment until it is completed is also a role of medical biller.
If somehow any bill goes unpaid, the biller will coordinate with the insurance company and ensure that the documentation is accurate. Sometimes the patient does not complete the payments within the specified time frame. In this situation the biller will turn over the debt to a collection agency.
Combining Billing and Coding
Medical billing and coding are connected directly to each other. A lot of healthcare organizations hire separate billers and coders, but they work closely with each other. The main objective always remains the same, which is to avoid any discrepancy.
Taking healthcare billing services from a medical billing company is a very great practice for ensuring the accuracy of claims. It takes off a lot of hassle from the shoulders of healthcare organizations.
Let's Simplify Your Billing
Partnering with a medical billing organization reduces a lot of burden for healthcare organizations. Unify Healthcare Services is a leading medical billing company providing its medical billing services in USA.
We take full responsibility for your documentation and ensure that it is completely accurate so that the claims can be reimbursed successfully. We handle billing for various healthcare organizations as well as individual practitioners.
Unify Healthcare Services ensure that your revenue cycle management functions properly by streamlining the entire process. We have expert coders who are trained to do accurate billing without any discrepancy.
We also make sure that we are always updated according to the latest guidelines and provisions set by the government or insurance companies. We never lag behind in technology, which keeps us ahead of our competition while being fruitful for our clients.
Unify Healthcare envisions transforming the healthcare industry by simplifying the billing process for organizations as well as individual practitioners so they can invest more time in providing better patient care.
