Introduction to Medical Billing and Coding

Let’s start our journey with a brief introduction to medical billing and coding. It doesn’t directly involve in patient care but it is the lifeline of healthcare system. It establishes a financial relationship between 3Ps namely patient, provider and payers involved in healthcare industry. In fact, this specialty has a great influence on the reimbursement procedure continuously running in the system, thus providers including doctors, medical offices and hospitals need to depend on medical billing and coding specialists to ensure steady flow of reimbursement from the insurer’s end.

Our healthcare providers are skilled enough to provide medical care and treatment to patients but they are neither specialist in medical jargon nor have detailed understanding of insurance rules and regulations. Moreover, everyday thousands of patients come to their offices for getting treatment. After providing healthcare services, now providers have to pay for all the bills. It includes the cost of medication and other utilities, lab charges, fees of doctors and supporting staffs. Now the question arises -is it at all possible for them to prepare correct insurance claims along with their supporting documents?
Introduction to Medical Billing and Coding

Introduction to Medical Billing and Coding

To cover the expenses and make their institutions profitable, healthcare providers seek assistance of medical billing and coding specialists who actively take part in medical claims preparation and submission to medical insurers. A medical coder’s duty is to assign universally accepted alphanumeric codes to diagnostic procedures that are performed on the basis of doctor’s visit to the patient. A medical billing specialist is responsible for dispatch the accurate claims to insurance companies and follow-up the entire procedure.
As you go deeper into the world of medical and coding, you may come across several terms that help you to understand this field.

A) Patient:

The patient literally means” one who suffers”. In general, a patient comes to a physician’s office or hospital to receive any kind of healthcare services. Most of the time, the person is sick or injured, and requires medical care and treatment by physicians and other healthcare providers.

B) Patient Demographic’s:

It is the list of all the basic information about a patient. It contains patient’s name, address, phone number, gender, date of birth, emergency contact information and social security number. It also includes the detailed information about his/her health insurance provider.

C) Policyholder:

A policyholder is an individual or a firm who holds an insurance policy.

D) Guarantor/Member:

An individual can purchase a health insurance for him/herself or for someone else’s e.g. child, spouse or parent. The person holding a health insurance policy visits doctor and he receives medical care and treatment .He is liable to make the remaining payment of his medical bills after insurance has paid. So, he is considered as the Guarantor. Now, a child goes to a hospital to get treatment. As he falls under his father’s health insurance, his father would be liable for all medical expenses and is treated as guarantor. Similarly, a company or a firm owns insurance policies on their employees and could be considered as the guarantor.

E) Practice:

In healthcare industry,”Practice” is a business term referring to the medical office. Sometimes, physicians individually run medical practices to provide health care services to patients.

  • Solo Provider Practice:It is the traditional practice of medicine, independently operated and owned by only one physician.
  • Group Medical Practice:Here, a group of physicians, dentists, physician assistants and various others specialists provide medical services to patients. They all work under the same premise and share one tax identification number. Group practice providers utilize their individual skills, knowledge and recourses for rendering specialized and comprehensive care to patients.

H) Healthcare Providers:

A healthcare provider may be an individual doctor or any facility providing medical care and treatments to patients and also generating bills for the products and services. In United States, there are three variations found in healthcare provider, namely private practices, health facilities and medical products and they cover up a wide area including hospitals, private health practices, outpatient clinics, nursing homes, pharmacies and long term care facilities.

An Overview of Medical Billing and Coding
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An Overview of Medical Billing and Coding
medical billing and coding is a systematic approach to ensure steady flow of reimbursement from the insurer for the services rendered to patients.
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