Computer Application For Medical Billing Essay

"Medical coding professionals provide a key step in the medical billing process. Every time a patient receives professional health care in a physician’s office, hospital outpatient facility or ambulatory surgical center (ASC), the provider must document the services provided. The medical coder will abstract the information from the documentation, assign the appropriate codes, and create a claim to be paid, whether by a commercial payer, the patient, or CMS." (Aapccom, 2015) It is very important that billing coders have a full understanding of how to properly use medical codes to prevent denial of claims submitted.

Medical billing translates a healthcare service into a billing claim. The medical biller makes appointments, transactions, and follows the claim to ensure the practice receives.

There are 6 key steps for a successful medical billing process which are checking in patients for their appointments. When you are checking patients in you will make sure the patient demographics is updated and correct. The second step would be checking the eligibility and verification for insurances. You will verify patients insurance because a change in a patients insurance could impact benefits and authorization information. The third step would be completing medical coding of diagnosis, procedures and modifiers. When completing this step you will need to make sur you are using the correct diagnosis codes to describe patient’s symptoms and illness, use the accurate CPT and HCPCS codes modifiers to provide additional information about the service and procedure performed. The insurance payer could only make an accurate assessment if they have they correct codes and modifiers. The fourth step would be the charged entry which refers to entering in the charges of the services that were received. The fifth step would be claims submission which means once the claim have been properly completed it should be submitted to the insurance company for payment. The final step in this process would be payment posting which involves posting and deposit

Id. In order for providers to avoid costly claim denials, a risk management and compliance program should be in place and annual monitoring and auditing of internal controls needs to occur on a regular basis. This text will review the issues that medical providers face with coding and billing regulations, the consequences of improper billing and coding, and resolutions that will aid in the prevention of claims being denied.

The process for medical billing involves a health care provider submitting, and following up on claims with health insurance companies in order to receive payment for services rendered; such as treatments and investigations. Once the procedure and diagnosis codes are determined, the medical biller will transmit the claim to the insurance company. Most physicians have medical directors that review claims for patient eligibility. Physician reimbursement and the coding to support it are critically important to the sustained health of any physicians practice. Under the contract provisions the physicians are responsible for rendering the services to the patients. In the billing process physicians need to know how services are rendered.

According to Rosenbaum et al. (2015), healthcare documentation combined with clinical communication that is coded for hospitalized patients is an important part of medical care. The paper or electronic healthcare record is then submitted to third party payers that provide reimbursement for services based on the guidelines of the Centers for Medicare and Medicaid Services (CMS), Medicare Severity Diagnosis Related Group (MS-DRG), and inpatient prospective payment system (IPPS) (Rosenbaum et al., 2015). The

The definition for Medical Billing is the process of submitting and following up on claims with health insurance companies in order to receive payment for services rendered by a health provider. The definition for Medical coding, is the process of converting diagnosis codes to ICD-9/10 codes and procedure codes into CPT codes. A Medical Biller and Coder may specialize in different areas. One area is in-patient facilities, and another area is in and out-patient facilities. An In-patient Coder works in an in-patient facility such as a nursing home, a rehabilitation centers or a hospital. Coders who work in hospital facility may utilize a different skill set, than those who work in a different kind of a health facility. A Coder needs to be

Data then flows into two functions: (1) the medical documentation, which becomes the basis for clinical decision making and goes into the medical record; and (2) the charge capture or entry, where the manual “charge slips” or automated direct order entry are priced in accordance with the price list referred to as Charge Master, also called Charge Description Master (CDM). Thereafter, data from both Medical Record and Charge master flow right into the billing system. Then, claims preparation follows by filling up of either of the two types of forms: (1) UB-04, which is used by hospitals for inpatient and outpatient service claims, or (2) CMS-1500, which is used by Physicians for professional claims. These forms are then carefully reviewed in the claims editing process to ensure there is enough information to warrant payment by the payer, and logical standards are complete and well documented. (Claims Editing is not conducted by all health care facilities, but is a critical effort to secure accurate and timely payment by payers). Finally, the claims are submitted to the payers.

In the medical billing revenue cycle, there are ten steps. The first step is patient preregistration where a patient schedules a visit and their insurance is either verified or on file. The second step is to determine the patient’s payment when visiting the provider and the reason for their visit. Next is to check the patient in upon arrival at their visit. This is to verify the insurance and the identity of the patient. The patient is checked out after seeing the provider and charges for services will show on the superbill. After this, the medical biller takes the patient’s superbill and creates a claim. From here, the biller must ensure that the claim is compliant with coding and arrangement. From here, the claim is prepared and finally

The key elements to a healthy and successful medical practice are a reliable and properly trained staff and a sound revenue cycle that produces satisfactory reimbursement. Revenue cycle management starts at the front-end with pre-registration of the patient. Complete and accurate recording of patient insurance and billing information is imperative. Insurance verification plays a major role in the assurance of reimbursement. The front desk should counsel and confirm financial responsibility with the patient during the registration process. Patient encounter is equally as important. Correct coding of patient diagnosis and procedures minimizes the likelihood of claim rejection. The next step in the revenue cycle is claim submission. The claims process begins with the provider treating the patient then sending a bill to the designated payer. Before the bill is sent, a certified coding specialist or medical billing specialist prepares and reviews the claim for any inaccuracies. There are a few ways the claim is submitted, either manually or electronically. Once the claim is submitted, follow-up with third party payers is a necessary step in the

This can be done electronically or manually. While most claims are sent electronically now, some circumstances require paper claims and it is required for a medical coder to know both methods. The form used is called a CMS 1500 form. On this form you will input information provided by the patient during registration, add codes addressing charges for services, document primary and secondary insurance coverage, and include provider and practice data where the services took place. Normally, every claim is reviewed by the billing department several times for accuracy before it is

The electronic health record has been developed to make things more accessible to different people that touch the patient care experience. Providers, billing departments, and insurance vendors would all access this information to provide a continuity of attention. The purpose of this is to be able to communicate medical records electronically to all the intended users of the information. It also allows for management of clinical data that can lead to better preventative care, management of chronic illnesses, and improve the financial health of practices (Crosson, Stroebel, & Stello, 2005). Electronic health record technology is starting to develop as the America government is pushing computerization. Many doctors don't like the electronic medical records because of the cost to their practice. Doctors look at the electronic health record as more money they have to pay out for someone else's

Medical field is one of the biggest fields. When I mention the word medical, the first thing come up to your mind are doctors or nurses. Some people that never work in a medical office, they don't know there are much more position in medical file you could work at, like medical assistant, technician medical coder or biller. Someone like me, don't like to deal with patient. Medical biller and coder is a good opportunity for me to work at. But what are medical biller and coder?

It is important to understand that patients are very satisfied with electronic health systems. For example, patients see a vast improvement in the speed at which they are being seen when they go their doctors’ office. Patients no longer have to wait on their physicians for hours due to the fact that their information can be readily available to their physicians when they come to see them. Moreover, all their information is transparent to their health care provider since all their data is in electronic form.

Who are Medical Billers and Coders? Medical Billing and Coding Specialist (MBCS) are the invisible engines of the healthcare system. They create invoices for all medical costs provided by healthcare providers and then submit the claims to patients’ insurance companies. They are also responsible for collecting co-payment s for a portion of the healthcare costs. A medical biller is responsible for processing insurance claims so the physicians and office staff get paid. Medical billing is done in a hospital, clinic or physician office. A medical coder work with ICD-9-CM, CPT, HCPCS, and/or ICD-10-CM medical codes making sure the procedures don for that patient are consistent with the diagnosis in the patient’s chart.