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Medical Billing & Coding: How it Works and Why It’s So Important

Posted: January 30, 2018

importance of Medical Billing & Coding

Are you interested in the Medical field, but unsure where to start? You might enjoy a career as either a Medical Biller or Coder. Here are some basics of both Medical Billing and Coding to help you understand this rewarding career path.

Medical Coding is a like being a translator. If you were a coder, it would be your job to take a doctor’s diagnosis or a prescription for a particular medication and translate it to a numeric or alphanumeric code. For every ailment, injury, diagnosis, and medical procedure, there is a corresponding code.

Sometimes it’s hard to keep track of the thousands of codes for medical procedures, outpatient procedures, and diagnoses. For example, a patient might come into a doctor’s office with a cough, mucus, and a fever. A nurse might ask the patient what their symptoms are and perform some initial tests. The doctor will examine the patient and may diagnose the patient with bronchitis. The doctor will then prescribe medication to the patient. The doctor or someone else in the healthcare provider’s office will record every part of the visit. The medical coder’s job to translate all relevant information in the patient’s visit into the proper codes, which will be used in the billing process. These codes are important to put in properly so that patients don’t have to pay out-of-pocket.

There are several sets and subsets of code that medical coders need to be familiar with but the most important two are the International Classification of Diseases (ICD) and Current Procedure Terminology (CPT). ICD codes correspond to a patient’s sickness or injury, while CPT codes correspond to the functions and services that the healthcare provider performed on the patient. These codes act as a sort of universal language for healthcare professionals, hospitals, insurance companies, government agencies, and other health-related organizations.

Every code has its own guidelines and rules. Some codes, like patients with pre-existing conditions, need to be placed in a certain order. The coding process closes when the coder enters the codes in a software program. Then the report is passed onto the medical biller.

Medical billers take the report from the medical coder and make a claim to the insurance company. Medical billers take the codes that show the kind of visit the patient had, the symptoms, the diagnosis and any prescriptions. Then, they make a claim for insurance using a form or software. The biller forwards this claim to the insurance company for evaluation. Once they return it to the biller, they then figure out how much of bill the patient owes the doctor after the insurance is taken out.

From the bronchitis-afflicted patient, if they have an insurance plan that covers the treatment for this condition, they will have a low bill. But, the patient may have a co-pay. In cases where patients are slow to pay, it is also the biller’s responsibility to make sure the healthcare provider gets paid.

If you’d like to learn more about the career of Medical Billers and Coders and how you might train to become one, check out Career Quest Learning Centers. Give us a call in Jackson at 877-365-8144 and Lansing at 877-481-4930.