My career that I am researching for my junior project is Medical Coding and Billing. Medical Coding and Billing are two different jobs. Medical Coding is when a patient has any medical procedure or exam such as going to the doctor for the stomach virus or even going to the hospital for a broken bone. They work with the insurance companies by putting a specific number into the computer. There’s CPT Codes which stands for Current Procedural Terminology which is “ Codes to better understand the services their doctor provided, to double check their bills or negotiate lower pricing for their healthcare services. (About Health, 2014).”
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.
When people think about jobs in the health care field, it can be easy to assume that most jobs involve direct, hands-on patient care. What many people don’t realize is that administrative jobs are equally vital to ensuring quality health care services. Medical billing and coding is an important piece in the administrative puzzle that makes up the vast health industry. As with most administrative jobs, medical coding and billing professionals need to have excellent attention to detail, as one wrong code or inaccurate statement can have an extremely negative
-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.
"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.
Internal and outside auditors have a heavy role and responsibility in performing audits, preventing major accounting errors, and following (GAAP) guidelines. Several duties comprise the role of internal and outside auditor to follow specific protocol and ensure ethical standards are priority. The National Health Care Billing Audit Guidelines are relevant to address as well as why audit failures happen. Finally, how internal vary from external audit and why audits are overall important to health care organizations. It’s vital for health care organizations to maintain all necessary standards to conduct proper audits and uphold ethical standards for the financial health of the organization.
* To attain the goal of becoming a medical coding auditor there are a number of skills needed, many of which I have and some that I will gain in the next few years as part of my career action plan. The skills I currently have to meet the first part of my career goal (to become a medical coder) are: Basic computer skills, understanding of how to use Microsoft office software programs, knowledge of health care terminology, completion of an AHIMA accredited certification course for medical coding and billing, and professional communication skills.
Some estimate that the federal government loses 30 percent of every dollar it spends on medical claims, due to medical billing mistakes and fraud. With so many loopholes and regulations surrounding Medicare, it is impossible for one person to know every nuance. However, constant diligence and ethical practices are a cornerstone of catching and preventing medical billing mistakes.
Launched as a community for curious career seekers, medical coding students, new medical coders, and medical coding rockstars, this blog is for those destined for success. We assume a professional, upbeat, and witty mindset, because I believe the business of medical coding doesn’t have to be boring. In fact, it’s quite exciting!
Training- Training methods for those interested in pursuing a coding career include college-based programs that contain coursework in medical terminology, anatomy and physiology, health information management, pathophysiology, pharmacology, ICD-9-CM, ICD-10-CM/PCS, HCPCS level II, and CPT coding, and reimbursement methodologies. Many college programs also require students to complete a non paid internship (e.g., 240 hours) at a health care facility. Professional associations (e.g., the American Health Information Management
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 billing for services not rendered for are often done as a way of billing Medicare for things or services, that basically never occurred. This can involve forging the signature of those enrolled in Medicare or Medicaid, and the use of bribes or as Healthcare calls it, kickbacks to corrupt healthcare professionals. Upcoding of services is the act of billing Medicare programs for services that are more costly than the actual procedure that was done. Upcoding of items is also very similar to upcoding of services, but it involves the use of medical equipment. For example, billing Medicare for a highly sophisticated and expensive wheelchair, while only giving the patient a manual wheelchair is upcoding of items. Duplicating claims occur when a provider does not submit exactly the same bill, but alters small things such as the date in order to charge Medicare twice for the same service rendered. Therefore rather than a single claim being filed twice, the same service is billed two times in an attempt to receive payments from the government twice. Unbundling involves bills for particular services are submitted as fragmentary, which appear to be staggered out over time. Although, these services would normally cost less when bundled together, but by manipulating the claim, a higher charge is billed to Medicare resulting in a higher pay out to the party committing the healthcare fraud. Excessive services occur when Medicare is billed for something greater than what the level of
A great opportunity to discover whether or not you actually want to do the job you have been dreaming about your whole life is to explore that career field. I was granted the opportunity to job shadow a medical records technician, also known as a medical biller. I haven’t always wanted to be a medical biller, but I have had an interested in the medical field. The chance to shadow Mrs. Latoya West at Advantage Medical Billing allowed me to see that the medical field was something that I would like to continue to pursue, but not as a medical biller. During my time, I did discover a few interesting things.
Medical billers, on the other hand, process and follow up on claims sent to health insurance companies for reimbursement of services rendered by a healthcare provider. The medical coder and biller process a variety of physician services and claims on a daily basis. Medical codes must tell the whole story of the patient's encounter with the physician and must be as specific as possible in regards to capturing reimbursement for rendered services. By majoring in health care administration I found that this type of coding pertains to my area of allied health. With this type of work, it could be very beneficial for the health care department. Reviewing clinical statements, is something that I watched a healthcare worker do while observing for my internship over break, it can often times get confusing and you have to be very cautious about the work you are
The new job title could be a medical coder 1. I choose this new title because the medical coder is a health care professional who analyzes the medical records, medical charts and assigns the appropriate codes. Most of the job’s responsibilities of a medical coder are required for the inpatient and the outpatient coder’s jobs. For example, medical coder’s responsibilities are: reading and analyzing patient records, determining the correct codes for patient records, interacting with physicians and assistants to ensure accuracy, using codes to bill insurance providers, and maintaining patient confidentiality and information security. In addition, the minimum required certification of this job is CPC or CCS and RHIT with at least 4 years of experience. Those certifications are given to a Coder who can read and assign correct diagnosis International Classification of Diseases or ICD-10-CM, Current Procedural Terminology or CPT, supply Healthcare Common Procedure Coding System or HCPCS code for a wide variety of clinical cases and services, and read and assign PCS codes. The skills of this job are same as the skills of the