Medical coding and billing are closely related components of the modern healthcare industry. These practices are both necessary for the reimbursement cycle to be complete. They connect patients, health care providers, and insurance companies. However, before beginning the medical billing process, medical coding must take place.
Both medical billing and coding can be done by a medical billing specialist or company. However, one can specialize in either medical billing or medical coding. Both the coder and the biller must have sufficient knowledge and a good understanding of the universal medical code language.
How Medical Coding and Billing Work Together
This process requires the coder to translate a prescription for a medication or a doctor’s diagnosis into an alphanumeric or numeric code. Every medical procedure, diagnosis or injury has a corresponding code, and there are thousands of codes. Therefore, a medical coder has to be familiar with the sets and subsets of the codes. The coder reads the medical care provider’s details of the patient’s visit and translates every bit of information into codes.
Every set of code has a specific set of rules and guidelines. Some codes, like those that indicate pre-existing conditions, should be placed in a particular order. The status of any claim depends on the accuracy and the specified guidelines of the code. Once the biller receives the coded report, a bill is made for the target insurance company. The biller gets an easier time when making the claim since information is used that everyone in the reimbursement cycle knows.
The medical biller sends the claim to the target insurance company, which examines and returns it. When the claim comes back, the biller analyzes it. After the analysis, the amount of a bill that the patient owes after deducting the insurance can be determined.
At Advanced Reimbursement Solutions, we understand that it can get confusing. With offices in Phoenix and Wilmington, we’re here to help. Contact us today to book an appointment and learn more about medical coding and medical billing.