Medical billing and coding are the nuts and bolts that help keep the healthcare system running smoothly behind the scenes. In a nutshell, it’s how doctors, hospitals, and health insurance companies communicate with each other. The medical codes are like a shared language that allows them to efficiently exchange information about medical procedures, services, diagnoses, and fees. Every service has a code, almost every diagnosis has a code, and there are codes for supplies, medications, and more.
These jobs are in high demand in the growing healthcare field. While the work can be complex, medical billing and coding also offer stable careers with good salary potential for those with the proper training and certification. Join us as we demystify the essential yet often obscure areas of medical billing and coding.
What is Medical Coding?
Medical coding is the process of translating medical records and patient encounters into universal codes that can be used for billing purposes, data analysis, and other applications. In the complex world of healthcare, these codes serve as a standardized language, ensuring that medical professionals, insurers, and researchers can communicate and understand the same information.
The ultimate goals are to maximize medical reimbursements, ensure accurate data reporting, and support high-quality healthcare services. Accurate coding provides the foundation for efficient medical billing and business intelligence across healthcare organizations.
What is Medical Billing?
Medical billing guarantees that healthcare providers receive compensation for the care and treatment they offer patients. By submitting and tracking claims with insurance companies, medical billing professionals help keep the healthcare system running smoothly.
The ultimate goals are to boost insurance reimbursements, cut down on denied claims, and maintain a healthy cash flow for healthcare providers. That way, they can keep their doors open and continue offering top-notch care to patients.
What is The Role of Medical Billers and Coders?
The medical coding process
Medical coders are professionals who have specialized training in understanding medical terminology and applying standardized codes to diagnoses and procedures. They review patient charts, including physicians’ notes, lab results, and other documents, to determine the correct codes for each diagnosis or procedure.
Examples of common medical codes and their meanings
International Classification of Diseases (ICD)
The ICD system codifies health conditions and ailments in a standardized fashion. Though the most up-to-date version is ICD-11, the previous version is still widely used in the United States healthcare system. Let’s check some examples of ICD coding below.
J02.9: Acute pharyngitis, unspecified – This code represents a diagnosis of acute pharyngitis (inflammation of the throat) without any further specification of the cause.
E11.9: Type 2 diabetes mellitus without complications – This code is used for patients diagnosed with type 2 diabetes without any associated complications.
Current Procedural Terminology (CPT)
CPT codes are used to describe medical, surgical, and diagnostic procedures performed by healthcare providers. Some examples include:
99213: Office or other outpatient visit for the evaluation and management of an established patient – This code is used for billing a routine office visit with a physician for an existing patient.
93000: Electrocardiogram, routine ECG with at least 12 leads, with interpretation and report – This code is assigned when a standard 12-lead ECG is performed, analyzed, and a report is generated.
Healthcare Common Procedure Coding System (HCPCS)
HCPCS codes are used primarily for billing outpatient and home health services and durable medical equipment. Examples of HCPCS codes include:
A9270: Non-covered item or service – This code is used when a service or item is not covered by insurance, and the patient is responsible for the cost.
J1100: Injection, dexamethasone sodium phosphate, 1 mg – This code is used for billing a 1 mg injection of dexamethasone sodium phosphate, a corticosteroid medication.
The medical billing process
This process is complex and includes multiple steps. The key aspects of medical billing are obtaining proper information, verifying insurance coverage, submitting accurate claims, and diligently following up and appealing denied or delayed claims to ultimately get paid for legitimate medical services. It requires patience, persistence, and organizational skills.
Billing Workflow:
- Obtain patient information and insurance details. Examples include the patient’s personal info, insurance card, policy number, and coverage details. If missing information, follow up with the patient.
- Check the patient’s insurance eligibility and coverage for the scheduled procedure or services. Verify deductibles and copays.
- Schedule the procedure or services and collect any necessary copays or deductibles from the patient.
- After the procedure/services, submit a claim to the insurance company including details of the treatment, diagnosis, costs, physician information, etc. This is typically submitted electronically.
- Follow up on the claim to ensure it was received and processed. Handle any requests for additional information from insurance companies.
- For denied claims, determine the reason for denial and file appeals or corrective claims when necessary. Follow up on delayed claims and those in “pending” status.
Potential issues:
- Missing or incorrect patient information resulting in claim denial. Have to contact the patient to obtain details.
- Lack of insurance coverage for the procedure. Have to notify the patient and determine how to proceed.
- Data entry errors on the claim form resulting in delays or denials.
- Lost claims requiring the biller to re-submit the information.
- Constant follow-up is required with insurance companies to get paid appropriately and timely. Multiple appeals are sometimes needed for denials.
- Staying up to date with the complex and frequently changing rules and policies of insurance companies. Continual learning is required.
What are The Benefits of Outsourcing Medical Billing and Coding?
Let’s face it, managing medical billing and coding in-house is a huge hassle for most doctors and healthcare providers. Between chasing down insurance claims, ensuring the accuracy of diagnosis codes, and staying up to date with the latest guidelines, it’s easy to see why these administrative tasks can quickly become overwhelming.
The truth is, for the vast majority of medical practices, outsourcing billing and coding just makes sense. It allows doctors and hospitals to trim costs, reduce errors and denials and lets them focus on what really matters – delivering quality patient care.
Outsourced medical billers and coders are specialists in their field. They have extensive experience navigating the complexities of insurance claims and staying on the cutting edge of coding guidelines. This means fewer rejected or erroneous claims, faster reimbursement, and less time wasted on administrative tasks. Freeing up staff from mundane tasks like billing, coding, and documentation also means substantial cost savings and increased productivity.
By outsourcing these routine tasks to expert agencies, hospitals can realize significant overhead reductions while boosting their team’s focus and output. Outsourced options provide massive cost savings versus the ongoing employment of comparable full-time positions. And with remote access, they function as a seamless extension of the existing team.
How Much Do Medical Billing and Coding Make?
According to the 2022 AAPC Medical Coding and Billing Salary Report, medical record specialists, which include medical coders and billers, earned an average income of $55,389 annually in the United States. But certified medical coders earn more with an average salary of $60,097 per year. By comparison, uncertified coders have a median pay of $47,200 per year.
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FAQ
How much do medical billing and coding make an hour?
According to recent data, the average hourly salary for medical billing and coding professionals is $26.34. Medical records specialists with no college education average $26.13 per hour, while those with some college or an associate degree may earn more. In the highest-paying states like New Jersey, medical billers and coders can earn up to $32.28 per hour.
Is medical coding a good job?
Medical coding can be a good job for many people. Experienced medical coders, especially those with certifications, tend to be paid quite well. Additionally, the demand for medical coders is growing rapidly due to increasing healthcare documentation requirements.
Are medical billing and coding hard?
Medical billing and coding can definitely be challenging work at times. These jobs require learning some pretty complex health insurance coding systems that are constantly changing and reviewing huge amounts of confusing medical documentation. Still, for the right person, medical billing and coding can be really meaningful, engaging work.
What is medical billing outsourcing?
Medical billing outsourcing means contracting with an outside company to handle some or all of a healthcare organization’s medical billing functions. Rather than employing staff internally, billing is outsourced to a third party.
