Medical Coding Archives - Advanced Reimbursement Solutions

What’s the Difference Between Medical Billing and Medical Coding?

While the terms medical billing and medical coding are often used interchangeably, they actually refer to two very distinct but related practices. The key to understanding the different responsibilities associated with each practice is to know the different tasks associated with each role.

How are They Both Related?

Medical billers and medical coders both work together to keep a healthcare practice running smoothly. Because of the important roles both of these providers play, individuals are often highly trained and prepared for success on the job. Both roles are critically important to the healthcare practice, and if either of them is not performed correctly, the results can be very detrimental to both patients and the healthcare agency. The modern healthcare industry heavily relies on skilled and certified medical billers and coders to record and manage each patient’s healthcare billing account.

What Does a Medical Coder Do?

Medical coders are health professionals who analyze a patient’s records to figure out what procedures were performed by a doctor, nurse, surgeon or related healthcare professional. They closely analyze these procedures in order to assign the right procedure or diagnosis code for any services received by the patient. This is a very important process in order to ensure the correct procedures are being performed and the correct diagnoses are being given. Because of the important role medical coders have in the healthcare services industry, they are often relied upon to get more info about a patient’s medical history.

What Does a Medical Biller Do?

Medical billers are involved in entering these into data logs and processing insurance claims. They are responsible for making sure that every patient is not being billed incorrectly. Medical billers often use highly advanced billing software for this process, which allows inputting medical codes and insurance claims to be sent to the insurance company for payments to be made. Because medical billers deal directly with insurance companies, they are expected to have a thorough understanding of the claims process and all other requirements that must be submitted in order to process the claim. They are also responsible for making sure the correct information was submitted to the insurer and that the billing format, all corresponding fields, and any supplemental documents to support the claim were included in the reports.

Advanced Reimbursement Solutions has a highly qualified professional staff of medical billing experts that can increase the efficiency of your billing operations. Contact us today for a professional consultation with one of our specialists in Wilmington or Phoenix.

4 Medical Coding Mistakes That Can Destroy Your Patient Satisfaction Score

Medical billing management is an integral part of modern healthcare. After a patient visits a doctor or medical facility, their insurance gets billed. But the healthcare world is changing to meet new regulations, and medical billing specialists should do the same.

In most facilities, medical billing takes place outside the clinic. Many medical billing companies now offer their services remotely, and accuracy is imperative. A minor error can make patients infuriated. Why?

Imagine receiving medical billing errors that force you to spend many hours on the phone. As if that’s not enough, you’re forced to pay for services you didn’t receive.

The surest way to maintain a good relationship with your patients is to avoid such mistakes. And that responsibility lies heavily on your medical coding. So to give you an edge, here are four coding mistakes to avoid.

Balance Billing

Balance billing is not a walk in the park. Sometimes it’s needed, and other times it’s illegal. It is not uncommon to find health plans suing out-of-network providers for failing to balance bill their patients. The best way to avoid such mistakes is to know the law and verify the patient’s insurance before billing.

Code Mismatch

As a medical billing specialist, your team should know that diagnosis and treatment codes must always match. A common mismatch that often gets patients mad is an upcode. In such a case, the insurance company will reject the billing and the patient will be held responsible for any additional costs.

Failing to Verify Insurance Coverage

Medical insurance coverage varies widely on conditions, procedures, and treatments. It’s the responsibility of healthcare providers to verify every patient’s insurance coverage. Keep in mind that the coverage can change at any time. And sometimes, patients don’t know about it. So before billing, always double check and validate insurance coverage.

Duplicate Billing

When a patient is billed twice or more for the same service, it results in duplicate billing. This error can originate from a doctor or a nurse when they request for a patient to be billed for a service or prescription. Sometimes, it occurs when a patient gets billed for several “first days” in the facility. This mistake can be so enraging because patients may have to spend many hours on the phone trying to remedy it.

Medical billing management is not cakes and ale. It takes a good team and a great system to get things right and enhance patient satisfaction. For assistance, get in touch with Advanced Reimbursement Solutions to speak with an expert in Phoenix or Wilmington. Contact us today to schedule an appointment and get started.

How Medical Coding Helps in Medical Billing

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.

Learning More

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.