What Is Medical Coding

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What Is Medical Coding:

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As you know, working medical coders and billers, as well as recent graduates from vocational training programs should seek certification as soon as possible to succeed!

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Medical Service Codes

A recent American Hospital Association survey showed that about 18% of billing and coding positions remain unfilled due to a lack of qualified candidates! The US Bureau of Labor Statistics states that medical billing and coding is one of the ten fastest growing allied health occupations. Their specialized training and skills lets them easily find work any place, any time.

Codes exist for all types of encounters, services, tests, treatments, and procedures provided by a healthcare provider in a medical office, hospital, or clinic. These codes are described as CPT4 codes that consist of 5 digit numbers. Even the simplest patient complaints such as headache, or nausea have codes which consist of a set of numbers and combinations of sets of numbers.

Art of Medical Coding

Medical coders are fundamental to medical record keeping. Every healthcare provider that delivers a service receives money for these services by filing a claim with the patient's health insurance provider or managed care organization.

Medical Coding Purposes

The American Medical Association (AMS) developed the CPT coding system. CPT stands for Current Procedural Terminology to tell the health insurance companies or government entities the reason why a patient was seen and what services were performed so that the provider can get paid. Codes also are implemented to gather and communicate public health statistics. Medical codes are used for a variety of purposes.

Among them:

coding diseases and procedures

physician billing and reimbursement

recording causes of death

The Encounter

When a provider sees and treats a person seeking medical advice in the medical office or practice it is referred to as an encounter. An encounter is defined as "a face-to-face contact between a healthcare professional and an eligible beneficiary."

The Medical Coder's Areas of Knowledge and Responsibility

KNOWLEDGE OF INSURANCE CLAIM AND REGULATORY CONSIDERATIONS. New patient interview and check-in procedures; established patient return visits; post-clinical check-out; computerized practice procedure methods.

COMPLETING CMS-1500 AND COMMERCIAL CLAIMS. Billing guidelines for inpatient medical, in/outpatient global surgery, minor surgery, and maintenance of a provider's claim files; setting up a filing system for completed claims; determining primary and secondary status; completing common types of claims.

KNOWLEDGE OF BLUE CROSS AND BLUE SHIELD PLANS. Features of BCBS plans; correct filing procedure; completing a BCBS claim form.

KNOWLEDGE OF MEDICARE. Parts of the Medicare program; eligibility criteria; fee schedule; supplemental plans and managed care; filling out an HCFA 1500 claim form.

KNOWLEDGE OF MEDICAID. Services covered under the federal portion of Medicaid; eligibility; services provided and paid for by state coverage; obtaining preauthorization for services.

TRICARE AND WORKERS' COMPENSATION. Health care for the military; deductibles, cost sharing and eligibility requirements for TRICARE; filing TRICARE claim forms; workers' compensation programs; classifying on-the-job injuries; preparing a First Report of Injury form; qualifying for workers¹ compensation benefits.

ICD-9-CM CODING. Using the ICD-9-CM coding system; primary vs. principal diagnosis; ICD-9-CM terms, marks, abbreviations and symbols; index tables.

CPT CODING. Basic format of CPT service and procedure codes on the CMS-1500 claim; comparing CPT with ICD-9-CM coding; modifiers; new vs. established patient; assigning emergency department and critical care codes; consultation vs. confirmatory visit; preventive medicine visits.

HCPCS CODING AND CMS REIMBURSEMENT. The HCPCS system for reporting professional services, procedures, supplies and equipment; HCPCS level II coding system; CMS reimbursement; rules of the Medicare physician fee schedule payment system.

CODING FOR MEDICAL NECESSITY. Assessment and coding from patient medical records; securing the correct physician documentation; coding an operative report; selecting and coding diagnoses and procedures from case studies and sample records.

Medical Coder's Job Security

Physicians depend on well trained, reliable medical coding and billing staff because otherwise they might not get paid for their services, or might wind up being charged large penalties due to improper coding, which could mean financial disaster, and cost them their livelihoods. Once hired, medical coders and billers hold secure jobs, with good futures. Supervisors spend weeks or months training medical billers and coders one-on-one. Once they are trained and have gained experience by participating in the daily office routine, chances are good that their positions will be long term.

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Benefits of Medical Billing and Coding Certification... Countless job seekers face barriers to employment and promotion because they lack professional credentials! Certified professionals are more readily hired at higher pay than their non-certified counterparts. Since 1989 over 150,000 health care professionals have earned the recognition and rewards gained from passing NHA certification exams. By attaining certification they have joined a growing distinguished group of knowledgeable and expert health care professionals. NHA grants Certified Billing and Coding Specialist credentials to: new graduates based on their training working individuals based on experience through NHA's Home Study Program		Reasons Behind the High Demand For Medical Billers Medical, therapeutic, and pharmaceutical services play an important role in our nation's economy! Driven by the ever increasing need for medical services wherever there are people the opportunities in healthcare related disciplines never cease to exist. There is plenty of room for men and women in healthcare occupations as long as they have the drive to achieve their dreams. Employment is not limited by location, gender, race, religion, or even disability. Recruiters and employers are readily hiring qualified staff to better serve their patients and clients; this includes medical billers, whose job it is to make sure healthcare providers get paid for the medical services they have provided in their community.