Basic Working of Medical Billing and Coding Process


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Most people see a doctor and give no further thought to the people who do the paperwork. But medical billers and coders, with their eye for detail and knack for detective work, play an important behind-the-scenes role in keeping patient records current and accurate, and bridging the gap between clinical care and administration. Medical coding and billing professionals are essential to the organization and management of health information and data for the purpose of billing patients and securing reimbursement from insurance providers.

Medical billing and coding careers serve to connect the clinical and business aspects of healthcare. Due in large part to factors such as aging baby boomers and federal legislation that has increased access to healthcare, the healthcare sector continues to grow. As it does, hospitals, doctors’ offices and other healthcare facilities are turning to medical billers and coders to handle specialized administrative duties. Although the job responsibilities of each can overlap?—?especially in smaller settings?—?each plays a specific role in the workplace. Here’s how the process typically works:

A look at how medical billing and coding (MB&C) professionals interact with healthcare providers, patients, and insurance payers.

Step 1 
Patients see a physician or undergo treatment, anything from a simple annual checkup to a complex surgery

Step 2 
Medical coders review diagnoses, test results, procedures, and other information, and assign them the corresponding medical codes.

Step 3 
Medical billers enter coded information onto bills in the proper order and form, and then submit them to insurance companies or individual clients for payment.

Step 4 
Insurance companies review the categorization of procedures or treatments, and reimburse providers according to the terms of the coverage plan.

A career in medical coding and billing requires an education beyond high school; candidates earn at least a certificate, and often an associate’s degree, in this major. Certificates, degrees, and individual online medical billing and coding courses are now available at schools nationwide. Students interested in non-clinical roles in healthcare are ideal candidates for studying medical billing and coding. CIGMA Medical Coding Academy is an AAPC certified institute providing Medical Billing & Coding training in Kerala.