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Medical billing and coding is a two part system that is a fundamental function of the modern healthcare system. By codifying medical treatments, healthcare providers can bill insurance companies or individuals for the services they perform. This process in known as the “reimbursement cycle.”
To make things simpler, let’s split billing and coding into two seperate sections and explain what they are, and how they affect the larger healthcare systems, in a little more detail.
At its simplest, medical coding is the practice of giving every injury, diagnosis, and medical procedure a numeric, or alphanumeric, code. It is the responsibility of the medical coder to take the healthcare provider’s notations, such as a doctor’s diagnosis or a prescription for medication, and translate them, as accurately as possible, into one of these codes.
When a patient visits a healthcare provider, each section of their visit is recorded and passed to the medical coder who then translates the relevant sections of these notes in numeric and alphanumeric codes. Tests, diagnosis, medication and treatments all have an associated code.
While there are a range of codes that a medical coder will receive training in, the two most commonly used are the Current Procedure Terminology, or CPT codes, which correspond with the functions and services the healthcare provider performed on or for the patient and the International Classification of Diseases, or ICD codes, which relate to a patient’s injury or sickness.
These codes are a universal form of communication amongst the various bodies that make up the “reimbursement cycle” in our healthcare system. By using these standardized codes, the medical coder allows information to be passed between disparate organisations, such as doctors, hospitals, insurance companies, and government agencies. Once the healthcare provider’s information has been turned into the appropriate codes, these are then entered into a paper form or, more often, a software program and are then passed to the medical biller.
Medical billing is the process through which the codes, produced by the medical coder, are used to produce a bill for the functions and services the healthcare provider performed on or for the patient. This bill, often referred to as a claim, is then passed on to an individual or insurance company.
While, on the face of it, this might seem like quite a simple process, in reality it is a little more complicated. Once the claim is sent off to the insurance company it is then evaluated by their insurance adjusters and is returned to the medical biller. The biller then calculates what, if any, remaining amount is owed by the individual once the insurance payment has been taken out.
The biller is then responsible for contacting the patient to inform them of any outstanding balance for their treatment. In the unusual case that the patient refuses to pay the bill, the medical biller may have to hire a collection agency in order to ensure that their employer receives the proper financial compensation for their services.
Taken together, medical coding and billing form a link between patients, healthcare providers, and insurance companies. As a medical biller or coder you’ll need to be accurate, detail oriented and well organised as you’ll be a vital part of any healthcare provider’s staff.
As one of the premier Medical Billing and Coding Schools in Las Vegas, Northwest Career College employs established, seasoned instructors to teach you every aspect of medical billing and coding. Our student-focussed approach puts you first and we offer online and on-campus workshops to accommodate your work and family schedule.
We continue to support our students after they graduate as our experienced Career Services team works with you to help you find the medical billing and coding jobs in Las Vegas. Call us today on (702) 403-1592 to learn more about the exciting opportunities that our Medical Billing and Coding School can offer you!
Written by:
Nancy Ferrante, C.M.B.S. Medical Billing & Coding Program Chair
