Medical billing and coding professionals convey complex information regarding a patient’s diagnoses, procedures, prescriptions, and equipment into alphanumeric codes and then transfer them into the billing databases and patient records. These separate tasks may be handled by several different medical billing and coding professionals. Most people overlook or are completely unaware that all of this is taking place behind the scenes, not knowing that the accuracy of medical billing and coding helps everyone.

Accurate billing and coding insures that the physician’s office is paid for services rendered, it charges the correct amount to patients, insurance companies pay their fair share of medical expenses and additional expenses don’t come of out patient’s pockets, and it can help researchers identify trends to stop pandemics. This is why a competent medical billing and coding professional is invaluable.

What Does a Medical Billing and Coding Professional Do?

According to the U.S. Bureau of Labor Statistics, medical billing and coding professionals organize and manage health information data by ensuring that it maintains its quality, accuracy, accessibility, and security. Medical billing and coding professionals use various classification systems to code and categorize patient information for insurance reimbursement, databases and registries, and to maintain patients’ medical histories. Medical billing and coding professionals typically do the following on a day-to-day basis:

• Review patients’ records for timeliness, completeness and accuracy
• Record, organize and maintain data for clinical databases and registries
• Use medical coding classification software to assign clinical codes for reimbursement and data analysis
• Electronically record data for collection, storage, analysis, retrieval, and reporting
• Maintain confidentiality of patients’ records under HIPAA

Medical billing and coding specialists document patients’ health information, including their medical history, symptoms, examination and test results and treatments that are provided to patients.

Insurance Reimbursement

Health care providers depend on the reimbursements they receive from insurance claims to run their practices. If there is a hold-up in payment flow, it can be detrimental. According to 2015 data from the American Academy of Family Physicians, approximately 44 claims are denied per physician each month, costing them nearly $13,200 per year to rework. What’s more, a majority of these claims are never reworked. This means either physicians aren’t reimbursed for services provided, patients are denied the services they need, and/or patients are required to pay more out-of-pocket for covered services.

Most denied claims result in oversight errors by staffers, such as entering incorrect information, mixing up point of service codes or ICD-10 codes, or failing to input codes for every procedure completed. Other common errors include duplicate billing, not verifying current insurance coverage, or not having the Explanation of Benefits (EOB) attached to a denied claim. Most errors are completely avoidable on the part of the medical billing and coding professional. That’s why competency and attention to detail are so important in medical billing and coding.

Patient Records

Translating a patient’s diagnosis, prescriptions, and procedures accurately isn’t just important for insurance reimbursement, it’s also vital for maintaining thorough and accurate patient records. Medical billing and coding professionals handle a patient’s data and services from the point of admission to discharge. This is why electronic medical records should be used even though there are still going to be some user error.

Any mistake, such as leaving out complications, symptoms, or pre-existing conditions, can result in a patient not getting informed quality care. For example, an error can result in a patient with a chronic disease not being considered for a disease management program. Plus, when subsequent providers see the record, they won’t have the full picture of the patient’s condition. With electronic health records, every physician or medical assistant that treats the patient will know their history. This means it is invaluable to have a medical billing and coding specialist that can master medical software.

Double Billing

The medical billing and coding professional should have a robust audit system and filing procedure to counter against submitting a bill twice. Double billing is inefficient and causes problems with the insurance claims. Medical billing and coding professionals are ideally placed to establish audit processes within the office to prevent overbilling.

A medical billing and coding professional needs to master coding, checking the detail are all vital steps to take in avoiding double billing errors. They also help maintain an efficient medical office and ensure bills are processed in a timely way.

Other ways that over billing may be submitted by the medical billing and coding professional is accidently billing for services not provided. The medical billing and coding professional will need to double check coding that is performed by the physician or medical assistant that is unreadable. An unqualified medical billing and coding professional may bill for a service that is covered in a global fee. Other billing errors a medical billing and coding professional should be aware of is upcoding to get paid for a more complex procedure than was performed. With proper training, a medical billing and coding professional can avoid all the pitfalls in medical coding.

Data Analysis

Accurate coding is necessary for healthcare data analysis. Claims data can be examined to assess everything from treatment outcomes to disease prevalence within a population. This data analysis can also find trends in more complex statistical modeling that predicts specific disease outbreaks. When this data is input correctly and provides a complete and thorough picture of each patient, analysts can target susceptible populations and generate solutions to improve health outcomes. Therefore, competent medical billing and coding professionals aren’t simply crucial for a smooth-running healthcare practice; they are vital component ensuring the delivery and quality of healthcare as a whole.

For a prospective medical billing and coding professional, this information should offer a push to take part in this in-demand career path. However, it also brings on the heat– as it’s extremely important for these professionals to do their jobs well. The medical industry needs more professionals who can quickly and effectively examine, interpret, document, and track complicated medical data. Individuals who can are absolutely invaluable in today’s healthcare practice.

Did learning how invaluable medical billing and coding professionals are interest you in becoming one? Gwinnett Colleges & Institute’s Medical Billing and Coding programs will provide you with the opportunity to learn insurance coding and processing, medical administrative procedures, and the regulatory requirements in the healthcare delivery system.  School externships provide the opportunity to apply the medical billing and coding skills learned in the classroom in actual medical settings. Gwinnett Colleges & Institute offers medical billing & coding courses to gain essential skills and training to achieve entry-level positions in this career field. These medical billing & coding courses will be the first step in starting a rewarding career.

Contact us to learn more about how you can become a medical billing and coding assistant today.