Medical coding and Billing

  

What is Medical Coding 

Medical coding is the transformation of healthcare diagnosis, procedures, medical services,

and equipment into universal medical alphanumeric codes. 

Medical coding is mainly classified into three types. They are

CPT  (Current Procedural Technology)  

ICD   (  International Classification of Diseases)

HCPCS  (Healthcare Common Procedure Coding System)

CPT is a medical code that is used to report medical, surgical, and diagnostic procedures

and services to entities such as physicians, health insurance companies, and organizations.

ICD is a set of medical codes published by World Health Organization (WHO).

HCPCS is another medical code developed by the Centres for Medicare and Medicaid.

Healthcare BPO and Medical Coding

Medical coding is crucial of all the steps involved in revenue cycle management process.

When the medical code is inaccurate, it fails to provide the complete medical history of the

patient. These medical codes are the basis for medical billing process and insurance claims.

The claim submitted to the insurance companies are based on medical codes to receive the 

payments on time for the services provided by the healthcare professionals.

Accurate medical coding brings less chances for claim denials and rejection by increasing 

revenue growth and strengthens the revenue cycle management process.

Challenges in Medical Coding

1. Not coding the highest level

As we’ve mentioned in the previous courses, the coder’s job is to code to the highest level of

specificity. This means abstracting the most information out of the medical reports from the provider

and taking accurate notes. It also means knowing the medical terminology for both procedures and

diagnoses. Coding to a general level, or under coding (which we’ll discuss in a moment) can lead to a

rejected or denied claim.

2. Under and over Coding

We mentioned these in Course 3-7, but they’re worth mentioning again. Under coding is the purposeful

reportage of less expensive medical services than were performed, while over coding is the reportage

of more expensive procedures than were performed. Both of these are fraudulent, and can lead to audits

and investigations. These aren’t errors, per se, but we’re obligated to mention them here as something

you absolutely must avoid.

3. Unbundling

Like under- and overcoding, unbundling is not so much of an error as it is a fraudulent practice.

Unbundling is closely related to upcoding, in that it involves false reporting designed to earn the

provider a higher payout from a payer. Unbundling means separately coding procedures that would

normally be included in one umbrella code.

What does a medical coder do?

Medical coders are the individuals responsible for translating physicians' reports into

useful medical codes. These professionals work behind the scenes in a variety of settings, ensuring all

pertinent information is coded appropriately to ensure consistency and accuracy. 

Set of medical codes published to define medical procedures has a role to pass the information

in a way it's efficient. Medical coder work anywhere that provides healthcare services

including healthcare BPO. 

Benefits of Medical Coding

1. Reduce and control operating cost

Today there are several coding and IT tools that are available to increase the speed, cost and accuracy of

medical coding. However, tools like Healthcare Common Procedure Coding System (HCPCS), ICD-9,

E-Clinical Works, Practice Admin or Kareo are not only expensive, but are also difficult to acquire,

maintain and upgrade. Keeping these tools in-house would require additional management. Your

healthcare center can avoid the cost and the problems of maintaining technology in-house through

outsourcing.

2.Better focus on healthcare

For quick and accurate medical coding to happen, you will need an expert team of AAPC

certified medical coders who have a deep understanding across medical specialities and

compliance requirements. Maintaining an in-house team of coding professionals can be tough,

while not resulting in a high ROI. You will also have to incur the cost of recruiting and

 retention. Instead, when you outsource medical coding, you can completely focus on healthcare.

3.Scalability

  An outsourcing service provider can ensure the quick deployment of medical coding services, while

 ensuring that the services are scalable and aligned to your business requirements. Your healthcare

 center or hospital will find it extremely difficult to shrink or expand your in-house coding team based

 on business trends or other such imperatives. However, with outsourcing, you will not have to worry

 about the infrastructure or volume needed to manage medical coding at any point of time.