What Is Medical Billing and Coding?

Medical billing and coding translates diagnoses, procedures, and treatments into alphanumeric codes that are used for insurance reimbursement. You go to the doctor’s, you get a bill, and probably without you even understanding the process, everything that happens is coded so you only pay what you’re required to and the doctor gets paid for the services they provide. Billing and coding each have their own distinct processes and guidelines, but they work together to make sure that medical staff and facilities get paid what they deserve and you get the benefits you’re entitled to.

Medical Billing and Coding Translates Data Into Codes

Every symptom, disease, injury, and surgical procedure has a medical code. Instead of entering a long list of ailments and treatments on every insurance form, the healthcare industry uses standardized codes that are recognized by medical organizations and insurance companies alike. These are the three types of codes:

• The International Classification of Diseases (ICD-10)—Includes codes for every disease or injury and basic medical procedures. Common codes include R05.1 for acute cough, E11.9 for Type 2 diabetes, and Z00.00 for a general medical encounter that included abnormal findings.
• The Current Procedural Terminology (CPT)—A more comprehensive set of codes for medical procedures and office visits. Common codes include 97110 for physical therapy and 36415 for a blood draw.
• The Healthcare Common Procedure Coding System (HCPCS)—This set of codes is used to describe medical equipment, supplies and non-physician treatments. Common codes include E0424 for oxygen systems and J9000-J9999 for chemotherapy drugs.

If you work in medical billing and coding, you don’t need to memorize all of the codes, but you do need to know how to look them up. Over time, what started as a foreign language to you, will become something you automatically know. You’ll know many of the codes by heart and will be able to use them to translate doctor’s notes, reports, and tests into data that’s stored in the Electronic Health Record (EHR). This ensures that medical records are accurate and updated and kickstarts the billing process.

Managing Medical Billing

After a patient visit or medical procedure, the billing department needs to submit an insurance claim. The codes that were entered into the EHR are submitted on the insurance forms to ensure the facility is properly reimbursed for services. Accuracy is important because the wrong codes can result in a claim denial or delay. When that happens, your job as a medical biller is to fix and resubmit the claim. You may have to call the insurance company to find out why it was denied and what error may have led to the denial. If the insurance company will not cover the full cost, or if the patient does not carry medical insurance, you then create and submit invoices to the patient for payment. You track and process these payments and follow up when they’re not received.

Why Is Medical Billing and Coding Important?

Medical billing and coding keeps a healthcare facility financially stable. Without a financial flow from insurance company to facility, operations and patient care would be disrupted. Medical billing and coding also creates an accurate and transparent record of services provided and paid for, reducing instances of fraud. And it ensures that medical records are accurate, which is important for both facilities and the government, which uses coded data to track public health trends, evaluate outcomes, and allocate resources effectively.

Have you ever thought about a healthcare career? The Medical Records Specialists who handle billing and coding are in demand and you can learn the skills you need to become one online. Charter College offers an Online Associate of Applied Science in Medical Billing and Coding that can prepare you for an entry-level job in the field in as few as 15 months. Call 888-200-9942 or fill out the form for more information.