General Overview of the Medical Billing and Coding Process

Medical billing and coding is the part of the administrative side of the health care system that deals with and manages the medical care revenue cycle.

It is the process that makes sure health insurance claims for services rendered to insured patients are reimbursed by the insurance companies.

Medical billing and coding is an important part of the health care industry because of the popularity of using health cards to obtain and pay for medical care services. Without the people taking care of the revenue cycle at the administrative offices of hospitals and clinics, the physicians will have a hard time asking for reimbursements or payments from insurance companies and it will have a negative impact on health care services.

To further explain the tasks performed by the medical billers and coders, here’s a quick overview of their tasks.

Insurance verification – this part of the process performed by medical billers and coders require verification of the authenticity of insurance credentials provided by patients. The insurance coverage will also be determined here.

Patient information recording – this part of the process involves recording the patient’s personal information as required in filling claims.

CPT and ICD-9-CM coding – this is all about applying the standard medical codes to services rendered to patients.

Charge entry – this is all about booking the amount equivalent to services rendered.

Claims submission – is the actual process of preparing the claim form and submission of the claim to the insurance company. This can be performed using the traditional mail process or electronically via the facilities in the insurance company website.

Payment posting – this is the process where settlements or payments from insurance companies are monitored and booked.

Follow-up – this process is all about checking up on the status of the claim.

Denial management – is about the process of handling rejection of claims by the insurance companies. If corrections are needed then the medical biller and coder will do it here.

Reporting – this process gives the management concrete feedback on the status of the revenue cycle.

These processes should be mastered by the medical biller and coder. If you are interested in starting a career in this allied health care service, you need proper training. You must learn about human anatomy, physiology and diseases, the medical language and terminologies, health insurance and reimbursement, and CPT and ICD-9-CM standard medical codes. You can gain knowledge of all these through proper professional training

The above processes are the ones medical billers and coders perform. I hope this gave you a good idea of the tasks performed by medical billing and coding professionals.