Often mistaken for the same, medical bills and medical codes are two distinct independent jobs. Although there are many similarities between the two, small health care institutions may entrust one person to accomplish both tasks; most medium and large medical institutions have different people responsible for these two different jobs. Both of these tasks belong to medical records and health information technology personnel. To understand the difference between medical codes and medical bills, let us look at the responsibilities of the two work files.
Medical code
Medical coding involves assigning relevant codes to various treatments given to patients to facilitate their insurance claims. The medical coders study the patient's medical records to determine the procedures that the doctor, surgeon, nurse, and other members of the medical team perform on the patient. They check the doctor's transcription, laboratory results and other documents related to patient treatment. If no further details or instructions are required, the medical coder will assign the correct diagnosis or procedure code to the appropriate service to the patient and create a claim paid by the insurance company. The current program term [CPT] assignment code is used for the procedure received by the patient and the International Classification of Diseases [ICD] for the physician to diagnose the patient.
It is critical that medical coders are accurate in the coding process because insurers use this data when processing patient claims. Medical coders often need to interact and coordinate with other health care and staff to gather more data about patient care or to inform them of the type of data and information needed in their medical records to ensure that the coding process is smooth and effective.
Medical bill
Medical billing involves checking the specified medical code and transmitting the claim. Using the developed proprietary software to enter the code assigned by the medical encoder and other relevant insurance information, the medical bookkeeper forwards the insurance claim for payment. Once the insurance claim is forwarded, the medical bookkeeper will continue to contact the patient and the insurance company to ensure that the claim has been paid. If the delay, refusal or rejection of the claim, the medical bookkeeper needs to contact the patient and the insurance company in order to sort the problem and resubmit the claim with the necessary adjustments; if the insurance company requires it.
When a health insurance company obtains insurance information from a patient, it often has to explain its benefits and answer questions about insurance. If the patient asks, they are also responsible for clarifying any questions about the cost of the bill. The medical bookkeeper is also responsible for interpreting the deductibles, co-payments and co-insurance required by the insurance company in case the patient asks to know why they still need to pay the premium. At the same time, medical expenses personnel must be aware of the claims process and be familiar with all the requirements that must be submitted when processing a claim. Before submitting the claim to the insurance company, their job is to ensure that the correct billing format is followed, all questions are answered correctly and all supporting documents are attached.
Health insurers must also ensure that insurance companies pay medical services to doctors and health care providers.
Commonality
It is important that both the medical coder and the payer pay attention to detail and ensure that the code entered into the system and all other insurance data are accurate. Both of these tasks require interpersonal skills because they deal with health care providers, patients and insurance representatives. Most importantly, both medical coders and medical staff are honest, as the law requires that patient data be kept confidential.
Orignal From: The difference between medical coding and billing
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