The main purpose of medical billing and coding is to streamline the reimbursement measures of the healthcare system to ensure that providers are compensated for their services. Proper billing and coding are also important for patients to protect them from inaccurate charges. These services are essential for any facility delivering patient care.
What Is Medical Billing and Coding?
Billing and coding are not synonymous. They are separate activities within the reimbursement revenue cycle of healthcare.
Medical Coding
Coding involves the translation of health information and data into a universal alphanumeric code. Data can include:
- Diagnosis
- Medical services
- Procedures
- Equipment used
- Types of patient visits
- Symptoms
The data is derived from patient charts, clinicians’ notes, and lab results, and then converted into codes that insurance companies can use to factor how much to charge patients and reimburse clinicians.
There are several types of code sets that a coder can extract from healthcare data:
- ICD-10 Diagnosis Codes: This coding system is maintained by the World Health Organization and is divided into clinical modification codes for diagnoses and procedure coding system codes for inpatient procedures.
- CPT and HCPCS Procedure Codes: These go hand in hand with diagnosis codes to indicate the services delivered by a clinician. The American Medical Association maintains the Current Procedural Terminology codes, while the Health Information Portability and Accountability Act requires the use of Healthcare Common Procedure Coding System codes.
- Charge Capture Codes: These are typically derived from a list of the facility’s prices for each service offered. These prices are used to negotiate the reimbursement rates for claims with payers.
- Professional and Facility Codes: Professional codes capture the services rendered by clinicians, while facility codes capture the overhead costs of delivering clinical services.
Medical Billing
Billing uses medical codes to create claims for insurance companies to ensure that a clinician or facility is compensated for services. Medical billers must also follow up on these claims to confirm that recompense is disbursed. If the insurance company is not involved, then medical billers send these claims as an invoice directly to patients. The overarching goal of accurate billing is to protect and optimize revenue so that clinicians and healthcare facilities can continue their services and maintain their equipment.
What Are the Requirements of a Medical Billing and Coding Specialist?
First, confirm that your specialist meets standard criteria. The following are the requirements to become a medical billing and coding specialist.
Education
Depending on your state or institution, varying levels of education must be met:
- High school diploma and healthcare experience
- A post-secondary certificate in health information technology
Certifications, Licenses, and Registrations
Certain employers require certification prior to hiring or require prospective medical records specialists to become certified after being hired. Certifications can include:
- Certified Professional Coder
- Certified Coding Associate
- Registered Health Information Technician
- Certified Tumor Registrar
To attain certain certificates, candidates may be required to pass an exam, complete an accredited program, and/or acquire coding experience in a work setting. Certifications typically need to be renewed regularly with continuing education credits.
As well, your prospective specialists should have the following set of qualities:
- Analytical skills: Due to the intricate nature of translating healthcare information into accurate codes and claims, the ability to analyze data is very important.
- Attention to detail: Specialists must be precise and deliberate with their coding to maximize claims for reimbursement.
- Integrity: Specialists must protect patient confidentiality as required by law.
- Communication skills: Coders and billers are often required to interact with the clinical and administrative departments of a facility to retrieve patient data.
What Are the Benefits of Outsourcing Medical Billing and Coding at Your Facility?
If your facility uses in-house staff to cover your reimbursement revenue cycle, opting to shift these activities to a dedicated team of experts can provide many benefits.
Quicker Insurance Eligibility Checks
This allows your facility to understand a patient’s benefits sooner so that you are aware of what services are covered or need pre-authorization.
Decreased Medical Coding and Billing Errors
An outsourced reimbursement team specializes only in medical billing and coding and can invest more time to prevent mistakes from occurring.
Protection of Patient Data
Most billing services have intuitive safeguards in place to ensure that patient privacy is maintained. Hacking is a real threat to patient confidentiality and professional billing services have protective measures in place.
Maximized Productivity and Service Delivery
Third-party billing companies can analyze your patient database for historical patterns to help your staff address patient flow more appropriately. With less time spent on billing activities, your staff has more time to dedicate to patient care and personal engagement.
Regulatory Compliance Maintenance
If your facility is deemed noncompliant with governmental regulations, you can lose compensation for services rendered. A third-party specialist can assist your facility to stay on top of required compliance measures.
Lower Administrative Costs
With less time needed to invest in the training and follow-up of billing specialists, your practice can devote more resources to expensive items, like new equipment or renovations.
Faster Claims Processing to Drive Cash Flow
Outsourced medical billing services can process insurance claims faster and issue payment reminders to your patients to keep the reimbursement revenue cycle at your facility moving.
What Are the Key Factors When Choosing an Outsourced Medical Billing and Coding Service?
To safeguard your practice from inept outsourcing, look at the following elements before hiring:
- Availability and staffing capacity of specialists
- Training procedures for specialists
- Regulatory compliance history
- Compatible coding software
- Cadence and content of billing reports
- Payer contract reconciliation
- Payment collection procedures
- Service fee structure
- Current client roster
These factors can guide your decision on which billing service to choose for your practice.
Where Can You Find Premium Medical Billing and Coding Services?
At Billing Direct, we connect clinical practices with quality billing services. We understand the importance of precise medical billing and coding and we also believe that outsourcing these services can improve the overall patient care at your practice. Contact us for a price quote specific to the services you deliver. We look forward to partnering with you.
