Explore a Day in the Life of a Medical Biller and Coder
Any time a medical service is provided, whether it is a routine checkup or a major surgery, information about that service is recorded and given to the medical billing and coding specialist. A doctor gives the medical biller and coder procedure documentation of the services provided, which the biller and coder must then translate into the proper code. Medical billing and coding specialist are responsible for correctly coding the diagnosis and procedures performed by the healthcare provider. This requires a thorough knowledge of both ICD-9-CM codes and ICD-10-CM codes for diagnostics, and CPT codes for procedures.
The bulk of the medical coding portion of the medical billing process involves turning procedure reports into correct medical code, then entering it into the system for the claims process. Medical coders spend their day taking procedure documentation, looking up the proper codes, and entering that information into their claims software. Most medical coding is relatively straightforward but even with common codes there are discrepancies or gray areas. Coders must consult their manual, professional associations, periodicals to stay up-to-date on current professional best practices.
The Revenue Cycle Process or Revenue Cycle Management (RCM)
RCM unifies the business and clinical sides of healthcare by coupling administrative, such as patient’s name, insurance provider, and other personal information with the treatment a patient receives and their healthcare data.
Communicating with health insurance companies is a key component of RCM. When a patient schedules an appointment, the physician’s office or hospital staff typically check the patient’s reported insurance coverage before the visit. After an insured patient receives treatment for a given condition and supplies any applicable co-payment, a healthcare provider or coder categorizes the nature of the treatment according to codes. The hospital or care facility then sends the care summary with ICD, HCPCS and procedure (CPT) codes to the patient’s insurance company to see what portion of the claim will be covered by insurance with the patient billed for the remainder.