Medical Field Coding Research Paper

properly documented and can be billed to you in the correct manner. Also, another use for medical codes is to protect yourself from false

As viewed by many HIM professionals Computer-assisted coding is a valuable tool for enhancing the effectiveness of coding and billing. CAC software scans medical documentation in the electronic health record (EHRs) using a natural language processing (NLP) engine, identifying key terminology and proposing codes for that specific treatment or service. Human coder then revised these codes. CAC can also investigate the background of key words to conclude whether they need coding.

Medical billing and coding specialists usually work in office settings. A computer, a telephone and appropriate documents are all used on a daily basis. Unlike other medical professions, there is little contact with patients. Medical coders work closely with healthcare providers and insurance carriers to gather and provide accurate billing information, but most communication take place in the form of phone conversations and mailings.

"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.

-Inpatient coders have certifications allowing them to work exclusively for hospitals or facilities. An expertise in medical record review is a must, along with an up to date status with coding rule changes, regulations and issues for medical coding, reimbursements and compliance under MS-DRG and Inpatient Prospective Payment Systems (IPPS). Coders should have experience as well as expert knowledge in abstracting information from medical records for ICD-9CM vol. 1-3, specialized payment in MS-DRG and IPPS.

Responsible coder collects post and manages account payments, submitting claims and keeping in touch with insurance companies. If patient information is coded incorrectly or incomplete it could leave an impact that can be brought to a claim. Inaccuracy in patient information can leads to denials, none payment and investigation. It is important to get all the details right by verifying insurance coverage properly. Make sure that the patient’s name is spelled correctly, date of birth and sex of patient are correct; and most important be sure that the policy number is valid.0verall before claims are sent, documentation should be in order and the claim should be checked for completeness and accuracy.

Read the article Diagnosis Coding and Medical Necessity: Rules and Reimbursement by Janis Cogley located on the AHIMA Body of Knowledge (BOK) at http://www.ahima.org.

The only department that will be utilizing the computerized coding assistant is the health information department mainly our coding staff. The HIM staff will mainly use this system in order to help smooth the coding process of charts, check to make sure all codes are correct before being submitted for billing, and to help them identify codes for diagnosis or procedures they are unfamiliar with. The receptionists in the different departments may also utilize the system if a time were ever to arise in order to assist the coders with work load.

AAPC was founded in 1988 implement education and professional certification to physician-based medical coders to elevate standards of medical coding by administering training, certification, networking and job opportunities.

1. A 54-year-old patient is seen by the physician in the outpatient clinic setting for CLL that is currently in remission. The patient's WBC counts, particularly lymphocytes remain within normal limits

Medical codes are assigned to procedures and diagnoses to bill insurance companies for the services doctors and other health care workers provide to patients. Diagnosis codes must be correctly linked to procedures to establish medical necessity.

Healthcare Coding and Billing Standards of ethical coding are very important and should not be taken lightly. When guidelines are not followed it can lead to large fines and can even cause a healthcare organization to shut down. Making a mistake or willingly coding wrong can ruin the reputation throughout the community for healthcare. “Coding compliance is inherently linked to a number of the preceding compliance risk areas including proper documentation, accurate billing, medical records creation and retention, referral guidelines, and teaching physician rules. Acknowledging that one of the biggest areas of risk for health care providers is the accurate submission of claims and reimbursement to Medicare, an effective health care corporate compliance plan will also include an effective coding compliance plan (AAPC, 2009).”

Responsible coder collects post and manages account payments, submitting claims and keeping in touch with insurance companies. If patient information is coded incorrectly, or incomplete it could leave an impact that can be brought to a claim. Inaccuracy in patient information can lead to denials, none payment and investigation. It is important to get all the details right by verifying insurance coverage properly. Make sure that the patient’s name is spelled correctly, date of birth and sex of the patient are correct; and most important be sure that the policy number is valid.0verall before claims are sent, documentation should be in order and the claim should be checked for completeness and accuracy.

The outmoded coding professional’s role was to describe and apportion diagnosis, procedure, and other medicinal service codes using ICD-9-CM and HCPCS/CPT coding classifications while referencing the Coding Clinic for ICD-9-CM, Coding Clinic for HCPCS,

specialist determine the ICD, CPT or HPCS coding. The coder or biller may have to communicate with the healthcare provider if there are any questions on any of the diagnoses, treatments or duration of the office visit (Dietsch, 2011). Because insurance companies are very strict on correct medical billing and coding, a small mistake can cause the insurance company to deny the claim and will then require the doctor to fix the error and the claim will need to be resubmitted (Cocchi & White, n.d.).