Have you ever thought of how the doctors you visit get paid for the services they provide you with? Or how does your health insurance company know what to cover and what to charge you? The eventual answer lies in a process called medical coding.
As we study the healthcare sector, medical coding is an unsung hero that ensures timely reimbursements and takes care of all the operations at the back end of the system. It is a fact that coding acts as an invisible link connecting insurance companies and healthcare facilities. This automatically explains the significance of coding within healthcare practices.
Welcome to the significant world of medical coding and billing! If you were looking for complete information on medical coding, you are in the right place. This comprehensive blog will let you know everything you need to know about medical coding. We will start with the basic definition of coding and later this roller coaster ride will explore the features, major classifications, the medical billing process, and its significance at the end.
Let’s Start This Journey Together
What is Medical Coding?
Medical coding refers to the process of allocating specified alphanumeric codes to the diagnoses, procedures, and services that are provided during a patient’s encounter with a provider/facility. The codes used are based on the International Classification of Diseases (ICD) system for diagnoses and the Current Procedural Terminology (CPT) system for procedures. The ultimate purpose of medical coding is to ensure accurate and consistent recording of medical information for various purposes. These purposes include billing, research, and statistical analysis.
These codes are for healthcare providers, insurance companies, and government agencies to document and bill for medical services provided by healthcare providers. The purpose is to translate medical information into codes that can be easily understood and processed.
A Journey Through the History of Medical Coding
The traces of medical coding are back in ancient Egypt and Mesopotamia. However, the revolution in the standardization of medical technologies came with the birth of the American Medical Association (AMA). During this time, the first edition of the International Classification of Diseases (ICD) was published in the year 1867.
The 20th century is considered a golden period for medical coding. This is because the ICD continued to evolve and finally, in 1979, ICD-9 was introduced.
1980s was the era of technological advancement. The AMA created and maintained current procedural terminology (CPT) codes. The 21st century was the period that marked the transition from ICD-9 to ICD-10. In recent times, the most advanced edition of ICD - ICD-11 was introduced in 2019 and came into effect globally on 1 January 2022.
Prime Classification System of Medical Coding
For understanding coding in an effective manner, there is a proper classification into different categories. Each type of classification has its own part to play. Hereunder is a brief overview of the general classifications:
ICD (International Classification of Disease)
The International Classification of Disease dates to the 19th century. It was in the 19th century that its first edition was published. Since then, ICD has undergone a journey of updates and revisions. This has helped it to become the best internationally recognized version. The use of ICD is to describe basic health conditions such as patients’ illnesses and injuries.
One thing to consider is that ICD codes are disease-specific and have additional numbers and digits to specify the health conditions. ICD codes differ regionally and have country-wise modifications in them.
CPT (Current Procedural Terminology)
Current Procedural Terminology (CPT) is a coding system that healthcare professionals use in the US to describe medical and surgical procedures. It is maintained by The American Medical Association. CPT is also known as HCPCS Level I. The purpose of these codes is to make communication easy among healthcare facilities and various insurance companies. Accurate billing is ensured with these codes, and they facilitate claim submission.
A codebook of CPT is revised on an annual basis, and all the updated CPT codes are mentioned. There are additional two-digit codes which act as modifiers and further clarify the healthcare billing scenario.
HCPCS II
It also includes some other services, such as ambulance, drugs, and durable medical equipment (DME). All of them are vital for billing and reimbursement processes.
Process of Medical Coding
There are seven crucial steps in the medical coding process. These steps successfully translate the diagnosis, procedures, and other healthcare services into various standardized codes. These codes are used in claim submission for getting reimbursement.
Let’s go through all the key steps:
Step 1: Interaction with Patients and Record Maintenance
The process of medical coding starts as soon as a patient visits the doctor. A proper record is maintained by the healthcare providers of services provided to the patient. It includes the diagnosis and medical treatments.
Step 2: Selection of Codes
The Professional coders undergo a complete process and do a thorough study of the documents before choosing the right code. The code should be according to the service provided. CPT is used for various procedures, ICD-10-CM is used for clinical information, and HCPCS II is used for non-physician services on the basis of services.
Step 3: Assign Code
After the code is selected properly, the coders move ahead to assign the chosen codes to the patient’s medical report. These codes are used and further processed for accurate submission of claims.
Step 4: Code Audit
To avoid claim denials and rejections, an internal audit is necessary. Many healthcare facilities have their own coding specialists who review the codes with scrutiny to check their specifications as per the coding guidelines.
Step 5: Submitting the claims
As soon as the codes are successfully audited, they are finally submitted to the health insurance companies. The claims that are submitted must include the demographic information of the patients, specific codes, and provider’s information.
Step 6: Adjudication and Reimbursement is Processed
When your claim reaches this stage of the process, the payer checks to decide if they will approve, deny, or reject the specific claim. Claims that are approved at this stage without any delay are processed further for reimbursement.
Step 7: Management of Denials and Appeals
If the claim is denied, the medical billing facility must explain the reason behind the claim denial. It is important that they appeal against the decision and connect with the insurance companies to resolve the particular issue.
Why is it Advantageous to Outsource Medical Coding Process
Maintaining medical coding accuracy is tedious but an essential task for every healthcare provider. The entire process of medical coding demands attention. No matter if the healthcare provider is small or big, medical coding is a challenge that demands undivided attention.
The most adept way to save money and time is to outsource the entire medical billing process to professionals, like Unify Healthcare Services. It is important to send the bills in a timely manner so that your account receivables don’t suffer, and the rates of collection are properly maintained. When you consider outsourcing the medical billing process, the entire thing is handled as a priority, and everything becomes quite straightforward.
All the tasks are tedious and make it difficult to focus on the primary activity of providing services. Outsourcing not only gives timely information but also improves the accuracy of the entire process and smoothness is ensured.
Let’s Discuss the Advantages of Outsourcing Medical Coding to Professionals:
Give time to focus on patient care
The billing process can sometimes be very demanding and cause additional stress for the healthcare staff. As soon as all your medical billing tasks are outsourced, it would be such a big relief to the entire staff of the healthcare practice. The most important part is that the entire healthcare can passionately focus on serving the patients. As the medical billing tasks are handled by experts.
Improves cash-flow and revenue
All the money that would otherwise be spent on creating infrastructure, getting medical billing software, and paying salaries to additional staff is saved. Expert billing companies have their own ways of getting claims approved by insurance companies. In this way, there is timely submission of claims and better revenue generation.
Reduction in Billing errors
As time changes and technology is updated, the rules and regulations of the medical world keep on evolving. Keeping up with these changes can be time-consuming and hectic. Once you outsource your medical billing process to professionals like Unify RCM, you don’t have to worry about rules and regulations and errors related to them. The experts work continuously to save your revenue cycle from unwanted errors.
Ensures consistent staffing
Unnecessary workflow disruptions like changes in staff and unwanted leaves or absences can put medical practices at a high risk. However, when you employ a medical billing partner to carry out all the operations, all these challenges can be smoothly eliminated. Medical billing experts like Unify RCM make sure that your billing process is not affected because of the absence of staff. The professionals ensure that everything is done correctly and on time no matter what is happening inside the organization.
Satisfaction of patients is improved
A patient is already in a lot of trouble when he visits the hospital. It is quite an inconvenient and tiring process. There are chances that they may have to deal with bad news and on top of it understand the complex process of paying the finances on various levels. In this case, all you need is a friendly staff to handle the patients who ensure that the patients are satisfied and happy in the entire process. On the other hand, the financial activities are handled by expert medical billers at the back end.
Stay updated about the changes
It requires a lot of attention to the medical billing process from the entire staff to stay updated. It can be tiring and lead to distractions. When you are taking care of the patients it can be annoying to keep up with the recent changes and fluctuations can be annoying. Medical billing companies make sure that healthcare is relieved from this tedious task.
Reliable when it comes to security
When it comes to security, there should not be any possibility of doubts regarding the same. The medical billing service providers, such as Unify RCM ensure data security as the platforms and tools that they use meet the HIPAA standards. When you connect yourself to a reliable and well-established medical billing company, one thing is for sure you will be fully assured that your data is stored with full confidentiality, coding compliance is maintained, and security is not compromised at any cost.
Minimize the chances of mistakes in Billing process
The experts in medical billing have core knowledge about the subject and they are aware of how to handle the lengthy billing procedures and processes. To complete the entire process correctly, they are given extensive training. Once they are full of knowledge and precision, they are capable of making sure that the much-needed medical coding accuracy is maintained throughout the process. This ensures a healthy revenue cycle in a healthcare practice.
Prepares you for the unexpected
The healthcare market is very unpredictable in nature as new coding guidelines keep changing and evolving consistently. To keep up with the unexpected changes in the industry, like – updated rules and regulations, changes in coding compliance etc, it is important to keep a check on what is happening.
Your medical billing partner, Unify RCM will prepare you for anything unexpected that comes your way.
How Unify RCM Helps with Coding in Healthcare Practices
It is time for you to not let complex medical billing and coding processes slow your healthcare practice down. Make the most of your time and resources with expert solutions from Unify Healthcare Services that will help maintain medical accuracy and accurate coding practices in the healthcare practice. We go beyond just getting the job done and focus on helping to create a healthy revenue cycle as part of your medical billing team.
