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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.

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