The process of medical billing and coding begins in the doctor's office. A patient's diagnosis and the services provided are translated by a certified medical coder into numeric or alphanumeric codes based on the International Classification of Diseases, 9th Revision Clinical Modification (ICD-9-CM), Current Procedural Terminology, 4th Edition (CPT-4) and Healthcare Common Procedure Coding System Level II (HCPCS). Once the services provided have been translated, the medical biller encodes the information into computer or paper based forms. Then, depending on the unique insurance and state regulations, the biller submits the claim to the insurance company for processing.
The medical biller also monitors the processing and payment of the claims. They follow-up non-payment and underpaid claims for the benefit of the healthcare institution. Another problem is frequent denial of insurance claims. Claims can be denied for any reason; the bottom-line is that denial negatively affects the revenue of a healthcare provider.
The time consuming nature of the medical billing and coding cycle lends itself to outsourcing. This eliminates associated headaches and time constraints; freeing up healthcare providers to focus on their core business of providing top quality medical services.
BACK TO TOP