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Monthly Archives: March 2019

Significance of Medical Coding and Billing

Medical billing and coding are two of the most critical components in any medical practice. Accuracy in both of these areas is critical to patient safety, rapid payment, and efficient operations. With a major portion of health care expenses being taken care of by health insurance, there is a huge demand for accurate and reliable medical coding and billing process.

As the payment for medical services provided is directly influenced by this process, health care facilities and medical practitioners cannot afford errors in it. Failure to implement accurate medical coding and billing system proves detrimental to the administration of any health care facility. On the other hand, affordable medical claims management, when implemented, provides enhanced collectible revenue of the practice.

Difference between a medical biller and medical coder

A medical coder’s main role is to decode the service or procedure written on the patient’s documentation provided by the healthcare provider, and then determines the appropriate procedure (CPT) and diagnosis code to submit. Medical coding workers spend time in assessing and properly coding the data, in order to ensure an accurate billing procedure is free of any errors.

Then, the medical biller inputs the claims with the appropriate codes and submits the claim to the insurance company for billing. The medical biller then, follows-up with the insurance company to make sure the claim has been approved, if there are any discrepancies or missing information, they reach out to the patient and let them know what is happening with their claim.

Importance of Accuracy in Medical Billing and Coding

Accuracy in medical coding and billing prove to be crucial for medical practices for perfect and timely submission of medical claims. Error-free and timely claim submission ensures getting reimbursement and reducing accounts receivable.

Impact of Inaccurate Billing on Patients

Errors in medical billing lead to patients being put under hardship. This, in turn, enrages them. Errors may impact patients in several ways, such as having to face financial trouble, having to spend precious time on the phone for explaining things, or being pushed to pay for services that actually were not provided. Apart from causing unwanted issues, medical billing errors result in patient dissatisfaction that doesn’t go well for the medical practice at all.

Some errors that can be avoided

Careless use of balance billing:

The practice of balance billing refers to a physician’s ability to bill patients for outstanding balances after the insurance company submits its portion of the bill. Out-of-network physicians, not bound by in-network rate agreements, have the ability to bill patients for the entire remaining balance. Balance billing may occur when a patient receives a bill for an episode of care previously believed to be in-network and therefore covered by the insurance company, or when an insurance company contributes less money than expected for a medical service.

Duplicate billing:

“Double billing” (sometimes referred to as Duplicate Billing) occurs when a provider attempts to bill Medicare / Medicaid and either a private insurance company or the patient for the same treatment, or when two providers attempt to get paid for services rendered to the same patient for the same procedure on the same date.

Undercoding/upcoding:

Overcoding and undercoding are two coding mistakes that can have damaging results in the medical office. Overcoding leads to insurance companies making much higher reimbursements than what the actual reimbursement should be. However, the penalties of getting caught far outweigh the advantages of getting a higher paycheck. Undercoding can result in the loss of revenue.

Why Medical Coders are the Superheroes in the Healthcare Industry

A medical coder typically codes the claims of a physician, hospital or a therapist. Unfortunately, it is understood that the responsibility of a coder ends with coding alone.

This is not true at all!

Medical Coders do much more than just coding. The job of the coder can vary and grow to more extents, based on the facility or organization that he/she works for. The Healthcare Insurance industry can never function without them. In short, they are the superheroes of the industry.

Let us look at some of the non-coding activities performed by Medical Coders:

1. They act as mentors

The medical coders are the right people to teach and mentor the healthcare industry and the healthcare insurance industry about the coding fundamentals and guidelines. The doctors and administrators also often get coached and receive a lot of crucial information from them about the guidelines.

2. They are on a learning curve always

Getting a job in coding does not mean that the coder has an easy job to do now and he can put his feet up in the air for life. On the contrary, a medical coder has to keep learning how to code unlearn and relearn periodically. Because the coding guidelines keep changing. Like the recent one, ICD 10 transition is going to affect medical coding. Learning new codes, additional guidelines, and mentoring the same across the industry are some of the major responsibilities of the coder. A minor issue in coding can mean that the claims getting denied or underpaid, which no physician or facility appreciates.

3. Deal with the denials

Speaking about denials and underpaid claims remind yet another job of the coders. They are often left to deal with denials, as same as the billing staff. Senior coders are often part of the denial management team. If a claim faces an issue, often coding is checked and, in case of continuous denials, a coder gets into action. He or she would have to check with the insurance company, if the codes are wrong, or reassure them why the specific code is present in the claim.

4. Coders have their plateful

Now, if the coders have received the appreciation of dealing with the codes, insurance knowledge, it is time to extend the applause. For they also take time to learn about LCD, NCD, policy guidelines, HIPAA rules, State and Federal laws and much more. They come handy to them, to keep off from errors.

5. They understand what the doctors mean

Pharmacists are often valued for understanding the writings of a doctor. Next time, the coders should never be forgotten. Pharmacists have the opportunity of reading the names of the pills and medication from the boxes. Sadly, the coders have a lot of patience to decipher what the doctor has prescribed. If there are nursing assistants taking a note of the procedure and treatment process, they have a great day dealing with different set of handwritings for a single claim.

Apart from these, the best struggle of the coder can be considered to have knowledge about the case studies, surgeries, and codes. Coders are often life science background or someone who has something to do with the healthcare industry. That does not mean they can understand all these, and yet, they often are required to discuss these topics, though not a physician.

Is Medical Transcription the right career for you? Find out!

When we think of medical transcription, a topsy-turvy handwriting on a piece of paper which very few people dare to read and understand pops up in our mind. But medical transcription is so much more.

What is Medical Transcription?

A simplified definition of medical transcription goes like this – ”Medical transcription, popularly known as MT, is an allied health profession dealing with the process of transcribing voice-recorded medical reports that are dictated by physicians, nurses and other healthcare practitioners.”

What are the goals of Medical Transcription?

The primary objective of medical transcription is accessibility or the easy availability of medical information. For instance, medical records of a patient can be made easily available once the audio-visual material of procedure performed on them get transcribed. The second goal is successful online marketing. A health provider advertises its business with the help of the story of its success in different cases backed by the carefully drafted and designed fact. And the third main goal is organizing the information for further purposes of research.

How does Medical Transcription work?

Doctors, nurses and other professionals working in the healthcare sector can use computer applications such as word processors to create reports, articles, and charts etc. Many don’t have enough time, skill or the desire to learn or deal with such programmes. When they need assistance to write for official purposes, they turn to the medical transcription services.

Medical reports can be voice files, notes taken during a lecture, or other spoken material. These reports are dictated over the phone or uploaded digitally via the Internet or through smartphone applications.

Given the complexity of the procedure involved in preparing medical transcription reports, there is high demand for manpower who can render and edit reports, procedures, and notes dictated by doctors in an electronic format, in order to create files representing the treatment history of any particular patient. People who render this service are known as Medical Transcriber (MT) or Medical Language Specialist (MLS). Health practitioners dictate what they have done after performing treatment procedures on patients and medical transcriptionists, or MTs, transcribe the oral dictation and/or edit reports that have gone through speech recognition software. A confidential and up-to-date medical information about a patient is converted to a written text document by a medical transcriptionist. Healthcare providers often prefer to store medical records electronically due to the whopping volume of hospital patients and the paperwork it needs. The electronic storage gives immediate access to subsequent departments of the service provider i.e hospitals regarding the patient’s care to date, notation of medications, their allergies etc. It helps establish a history on the patient to facilitate quality healthcare delivery regardless of geographical distance or location.The transcription text may be printed and placed in the patient’s record. It may also be retained only in its electronic format depending upon the need arisen. The transcription can be done by medical transcriptionists employed in a hospital, or by people who work at home as telecommuting persons for the hospital. MTs also work as telecommuting employees or independent contractors for an outsourced service that performs the work offsite under contract for a hospital, clinic, physician group or other healthcare services provider. They sometimes work directly for the service providers such as doctors or their group onsite.

How can you become a Medical Transcriptionist?

You can easily become a medical transcriptionist by earning a certificate degree in Medical Transcription. You will study and master medical terminology, business writing, typing skills, computer applications, and legal issues on healthcare documentation. Some certification programs include internships and fieldwork opportunities, giving them on-the-job training and helping them apply what they learned in the program. The certification lasts for a certain valid period and earned by passing an examination. To maintain the certification, transcriptionists need to participate in on-going education courses.

Conclusion:

Medical Transcription is a critical aspect of healthcare services. A certificate or associate degree in the medical transcription field is necessary and along with good experience, it can help your employment prospects.

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