WHAT IS MEDICAL BILLING AND CODING: Understanding the Meaning, Process and Course

If you want to work in healthcare but don’t want to be involved in direct patient care, medical billing and coding is an option to consider. However, if you’ve never done this type of work before, the thought of completing billing and coding duties in the medical profession may make this job appear difficult. For this reason, we’ve developed a list of items we believe you should know about this career path, including what the medical billing and coding salary is, the available course, its examples, and the 10 steps involved in the medical billing process, among others. Let’s dive in!

What is Medical Billing and Coding?

The process of recognizing diagnoses, medical tests, treatments, and procedures recorded in clinical documentation and then translating this patient data into standardized codes to bill government and commercial payers for physician payment is known as medical billing and coding.

What are Medical Billers and Coders Responsible for?

Medical billers and coders are healthcare specialists who handle patient data such as treatment records and insurance information. The medical billing and coding professions are both active in the medical reimbursement cycle, collaborating to guarantee that healthcare providers are paid appropriately and efficiently for the services they deliver.

Increasing demands on doctors and allied health clinicians, along with diminishing remuneration, necessitate investment in highly trained medical billers by medical offices. A thorough understanding of medical insurance, the claims process, the appeals process, and the impact on revenue provides the medical biller with the knowledge needed to improve revenue performance. The billing office’s effectiveness and overall performance determine a practice’s financial health.

Examples of Medical Billing and Coding

To help you understand what medical billing and coding is in a more practicle way, we have come up with some solid examples. Here is a more in-depth look at the practical display of medical billing and coding examples, just to demonstrate how billers and coders go about their daily work. We will give seperate examples both for the medical coding and billing respectively.

Medical Coding Example

In this medical coding example, the coder receives an abscess drainage patient record and must translate the information regarding indications, medicine, and procedure into medical codes based on intervention radiology CPT codes.

In this case, the first thing to do is describe the procedure: “CT guided retroperitoneal peripancreatic fluid collection and drainage.” Then, you will need to go over the symptoms to discover that the CT images show a lump that could be an abscess. You will then discover the use of moderate sedation. Finally, you will discover that the surgeon aspirated purulent fluid, which was then submitted to the lab for analysis.

The medical coder then converts all of the phases in this method into medical codes, utilizing your understanding of human physiology, medical terminology, and the Current Procedural Terminology (CPT) coding process, all of which you can learn through medical coding training.

Medical Billing Example

The workflow in this front-end medical billing example begins when a patient registers and schedules an appointment at a medical office or hospital. The medical biller collaborates with patient financial services employees to ensure that all pertinent information, including insurance coverage, is provided by the patient. Collecting correct and comprehensive patient information in advance lays the basis you will need for claims to be filed properly and promptly for payment.

Before the appointment, the biller confirms that the requested services are covered by insurance and provides the necessary pre-authorization to ensure that the provider is compensated. The biller will work out details like the maximum number of visits allowed and patient cost responsibility so that the information can be conveyed to the patient and payment can be collected at the time of the visit.

The medical biller will confirm a patient’s financial responsibilities and assist front-of-house employees in communicating this information to the patient. After that, the biller may assist the patient in developing a payment plan and collecting any required upfront payment.

What Is Medical Billing and Coding Salary

Determining what the medical billing and coding salary is, solely depends on a variety of criteria. These criteria include expertise, certification, geography, workplace type, and experience. One of the most important factors in deciding medical billing and coding compensation is location. We shall then describe the Medical Billing and Coding Salary based on a few popular states.

The medical billing and coding salary for:

California is $66,224
Alabama is $48,167
Florida is $55,823
Illinois is $54,929
Michigan is $53,273
New York is $61,700
North Carolina is $57,564
Ohio is $54,242
Pennysylvania is $57,178
Texas is $56,803
Washington is $61,806

What Are the 10 Steps in the Medical Billing Process?

The medical billing process is a sequence of stages that billing specialists must perform in order for medical providers to get reimbursed for their services. Depending on the circumstances, it may take a few days to complete, or it may take several weeks or months. While each medical office’s process may vary significantly, let’s look at what the 10 steps involves in the medical billing process are:

Patient Registration

It should come as no surprise that the first stage in the medical billing cycle occurs at the start of an appointment, or even before the appointment. The office staff gathers basic information about the patient, such as their name, date of birth, address, reason for their visit, and other details. They also record insurance information such as the provider and policy number so that they can immediately validate the information is correct. This may appear to be a simple procedure, but it is a critical initial step. If inaccurate information is put down during registration, it might cause problems later in the billing cycle and even generate claims issues if not corrected.

Confirm Financial Responsibility

This step entails a more in-depth examination of the patient’s insurance coverage. The staff thoroughly examines the patient’s insurance information to see whether the requested services are covered by their provider. If insurance does not cover something, the patient is notified that they will be financially responsible for those charges.

Create the Superbill

When the appointment is complete and you have all legitimate patient information, such as insurance, identification, and co-payments, it’s time to prepare the “superbill.” This report includes all existing information from the registration and appointment, as well as the diagnosis and billing codes.

Generate the Claim

You should now have all of the information you need to file a medical claim with your insurance company. Once a claim is created, it is critical to confirm that all information is correct and that no coding or billing problems exist. If you use Medicaid billing software for your claims, this is a straightforward check. The software will check for faults automatically before uploading, so you won’t have to worry about mistakes showing up afterwards.

Submit the Claim

Once you’re certain the claim is error-free, submit it to the insurance company. This step will differ slightly depending on whether you’re billing manually or electronically. If you are manually submitting, you will most likely take a large number of claims to the post office at once. It is simple to send each claim promptly when you use automatic billing software. Electronically billed claims will be paid first, so keep that in mind if you’re still on the fence about employing software.

Monitor Claim Status

You will now be subjected to a waiting period. During this time, the payers review your claim to ensure that the information is correct. After they’ve reviewed the claim, one of three things could happen: your claim is accepted and you’ll be paid; your claim is rejected and you’ll have to rectify any errors and resubmit; or your claim is denied and you’ll have to fix any errors and resubmit.

Create the Patient Statement

After the claim has been completed, bill your patient for any unpaid charges. This statement will detail the overall cost, including what services were covered by insurance and how much they paid, as well as what services were not covered and how much the patient owed.

Patient Follow-up

Depending on whether your patient pays their bill on time, this step may or may not be required. You must issue a follow-up statement if you do not receive a payment by the due date. If you haven’t received money or a response by then, you may need to call a collection agency.

Is Medical Billing and Coding Difficult?

This might be a challenging question to answer because what appears difficult to one person may appear easy to another. So, perhaps the best approach to answering this question is to provide a few of the tools that you could use to assist you in fulfilling your duties as a medical billing and coding professional.

As previously stated, both medical billing and coding rely on codes established by standard coding systems. These systems choose which codes to use based on the patient’s specific diagnoses, tests, or treatments.

Depending on the healthcare institution for which you work, you may have access to coding applications that can assist you in determining the appropriate code to use. This type of program can help you find the code you’re looking for by performing a rapid computer search.

While you may begin to memorize specific codes, especially if you use them frequently, having access to this type of software allows you to access the codes you require without having to learn each one by heart. Again, while this large number of codes may appear overwhelming, there are numerous tools accessible to assist you in performing medical billing and coding responsibilities. You can also find some medical billing and coding course and engage in them.

Is Medical Billing and Coding a Good Profession?

The job outlook or prognosis is one thing to consider when deciding whether medical billing and coding is a desirable career choice for you. In other words, are jobs in this field of healthcare expected to grow, remain stable, or diminish in the next few years?

According to the BLS, this increase is predicted due to an older population, extensive usage of EHRs, and medical registrar professions remaining in high demand. This all adds up to a larger demand for medical records specialists in the coming years. So if this is the case, you can go for it.

Is medical billing and coding worth it?

When it comes to the job outlook for a medical biller and coder, you’ll be happy to know that new jobs in this field will increase by 8.54% between 2020 and 2030. This equates to approximately 28,600 new jobs. Let us investigate more. There will be 335,000 medical billers and coders in 2020. In essence, it is worth it.

Can I learn medical coding on my own?

The short answer is “yes.” However, if you’re beginning from scratch, you’ll need to do your research. Literally.

Does medical coding involve math?

In truth, medical coding requires relatively little math. You need a small amount of math for the integumentary and musculoskeletal systems. Although it is not an essential skill set for the most part.

What are the two types of medical billing?

There are two types of billing in medical billing: professional billing and institutional billing.

How to pass medical coding exam?

To pass your medical coding exams you need to employ these steps:

Take a Full Medical Coding Course
Take a Review Class
TIMED Practice Exams
Don’t Overthink The Questions
Use a Strategy You’re Comfortable With

Conclusion

If you’re ready to pursue a career in medical billing and coding, this article is here to help. We have compiled so much information about medical billing and coding including some examples, 10 steps involved in medical billing process and salary according to various states. You can also scale up b signing up for a course on medical billing and coding, just to ensure you succeed on your career path. With this much guidance, I bet you won’t go wrong.