Medical Billing and Coding Essay

When I first entered into the medical field, I became a CNA (Certified Nursing Assistant). I love doing my job because I was able to help others in need. My career that I am taking is about medical billing and coding. you can also work from the comfort of your home. Since I have a disability that prevents me from working my previous career that I was in ,after not working for quite a few years I knew I needed to find a career that I could do and work from my home.

This is why I chose medical billing and coding after talking to some of my cousin who was in this field. there are several category within medical billig and coding that I will describe * The definition for Medical – code is the transformation descriptions that doctors and health care facility uses to describe healthcare procedures into a numeric or alphanumeric designations. Medical Billing and Coding Essay. This is a code number that is use to detail the accurately description of a diagnoses (what is wrong with the patient) and the procedures that was preformed to test or to correct these diagnoses.

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Because medicine is not always an exact science, these codes were developed to indentify all reason a person was seeking healthcare. Coding health related data permits access to health records according to the diagnoses and procedures for use in clinical care, research, and education. Some common use of medical codes in healthcare includes:Indentifying systems that must be evaluated. It also alert other health care professionals about a life threatening allergies. * Reporting services performed for reimbursement * Helping with administrative functions such as staffing, scheduling, and adding or decreasing healthcare services * Comparing facilities and planning for new services in underserved areasMedical Coding Profession Delivering quality healthcare depends on capturing accurate and timely medical data. Medical coding professionals fulfill this need as key players in the healthcare workplace. The medical coding professional (or coder) is esponsible for translating healthcare providers’ diagnostic and procedural phrases into coded form. Coding professionals do this by reviewing and analyzing health records to identify relevant diagnoses and procedures for distinct patient encounters. This translation process requires interaction with the healthcare provider to ensure terms are translated correctly. Coding professionals must possess a thorough understanding of the health record’s content in order to find information to support or provide specificity for coding.

Certified medical coders are trained in the anatomy and physiology of the human body and disease processes in order to understand the etiology, pathology, symptoms, signs, diagnostic studies, treatment modalities, and prognosis of diseases and procedures to be coded.Medical Billing and Coding Essay. The job entails much more than simply locating diagnostic and procedural phrases in the coding manuals or with encoder software. It requires knowledge of disease processes and procedural techniques to consistently apply the correct codes.

A medical coding professional works as part of a team to achieve the best quality patient careMedical coding professionals work in a variety of healthcare settings, including inpatient and outpatient healthcare settings and non-provider settings such as third-party payers and healthcare software vendorsTypical medical coding professional job descriptions include * , Hospital outpatient coder  * Hospital inpatient coder * Hospital coding manager * Professional fee coderRelated jobs, employing similar record analysis and coding skills, include: * ,p orhterHIM compliance specialistNationwide, there is a shortage of certified medical coders in hospitals, physician practices, and other healthcare facilities. According to the United States Bureau of Labor, employment of medical record and health information technicians is expected to grow much faster than the average field.

Coding Classification Standards The Health Insurance Portability and Accountability Act of 1996 (HIPAA) named certain types of organizations as covered entities, including health plans, healthcare clearinghouses, and certain healthcare providers. It also set the standards for the classification systems covered entities must use. Under HIPAA, covered entities must use certain codes to identify specific diagnosis and clinical procedures on claims, encounter forms, and other electronic transactions. : * International Classification of Diseases, 9th revision, Clinical Modification ICD-9-CM Volumes 1 & 2 (diagnosis codes) is maintained by the National Center for Health Statistics http://www. cdc. gov/nchs/icd. tm (NCHS), Centers for Disease Control (CDC) within the Department of Health and Human Services (HHS). * International Classification of Diseases, 9th revision, Clinical Modification ICD-9-CM Volume 3 (procedure codes) is maintained by CMS * Current Procedure Terminology (CPT) (outpatient procedure codes) is maintained by the American Medical Association. * Health Care Common Procedure Coding System (HCPCS)—This code set, established by the Centers for Medicare and Medicaid Services (CMS), primarily represents items and supplies and non-physician services not covered by the American Medical Association CPT-4 codes. More information is available on the CMS Web site. International Classification of Diseases, 10th revision, Clinical Modification (ICD-10-CM) is the new diagnosis coding system developed as a replacement for ICD-9-CM, Volume 1 & 2. International Classification of Diseases, 10th revision, Procedure Coding System (ICD-10-PCS) is the new procedure coding system developed as a replacement for ICD-9-CM, volume 3. Medical Billing and Coding Essay.The compliance date for ICD-10-CM for diagnoses and ICD-10-PCS for inpatient hospital procedures is October 1, 2013. More information on ICD-10-CM/PCS. * National Drug Code (NDC)—The NDC is a code that identifies the vendor (manufacturer), product, and package size of all medications recognized by the FDA. HIPAA also names specific standards for electronic transactions.

For example, submitting medical claims Transactions are electronics exchanges involving the transfer of healthcare information between two parties for specific purposes—such as a healthcare provider submitting medical claims to a health plan for payment. HIPAA adopted certain standard transactions for electronic data interchange (EDI) for the transmission of healthcare data. These transactions are: * Claims and encounter information * Payment and remittance advice * Claims status, eligibility, enrollment, and disenrollment * Referrals and authorizations * Premium paymentLearn more about how clinical classifications and clinical terminology systems work together to form the foundation of information content in the electronic health record (EHR).

Clinical Terminologies and Vocabularies Medicine’s complex language is represented in clinical terminology and vocabulary systems. Clinical terminologies represent terms related to the medical field while vocabularies are collections of terms. Both clinical terminologies and vocabularies provide a way to capture detailed data in an electronic health record (EHR). They support the transformation of paper-based to electronic records by providing a machine-readable data structure. Clinical terminologies are considered the input format while classification systems are the output format. Medical Billing and Coding Essay.

What is Medical Coding? In short, a Coder is someone who has a thorough understanding of the ICD-9 codes, Modifiers, and CPT codes and uses this knowledge to ensure the proper application. Coders most often review the work of the physician, apply modifiers, and check for errors in CPT code bundling or ICD-9(Diagnosis Code) appendage. For each procedure that the physician or NPP(non-physician provider performs, there is an applicable CPT code and associated Diagnosis code.

The CPT code is what and the ICD-9 represents the why behind the what. Medical coding is the most difficult job in a billing office because it requires constant learning and is highly detailed oriented. Many offices also use their coder to perform routine coding audits for the practice. These audits come in many different forms but the primary role of all audits is to ensure that all procedures billed for are properly substantiated and paid for. Many time audits are performed to ensure compliance with the documentation in the chart.

These audits are performed done to safeguard the practice from owing Medicare or other payers, refunds because of inadequate documentation and over billing. Many times, audits find that physicians are under billing for most services because they do not fully understand the way to code or they are afraid of being audited. There are different types of Coders and some are specialized in Hospitals, Private Practices or particular specialties. There a few different options when it comes to becoming certified and we have links to the different options on this site.

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Certification does not guarantee you a place in the coding workforce but it does place you above much of your competition. Medical Coding as defined by the American Association of Professional Coders is: Medical coding is a key step in the medical billing process.Medical Billing and Coding Essay.  Every time a patient receives professional health care in a physician’s office, hospital outpatient facility or ambulatory surgical center (ASC), the provider must code and create a claim to be paid, whether by a commercial payer, the patient or CMS.

While the medical coder and medical biller may be the same person or may work closely together to make sure all invoices are paid properly, the medical coder is primarily responsible for accurately coding the claims. To do so, he/she checks a variety of sources within the patient’s medical record, such as the transcription of the doctor’s notes, ordered laboratory tests, requested imaging studies and other sources, to verify the work that was done. To make sense of it all, a thorough knowledge of anatomy and medical terminology is essential.

It is also important that the medical coder is familiar with different types of insurance plans, regulations and, of course, CPT®, HCPCS Level II and ICD-9-CM codes and guidelines. This enables the coder to assign correct codes and service levels for the procedures performed and supplies used to treat the patient during an encounter as well as properly identify the physician’s diagnoses. The medical coder also serves to help document frequency of diagnoses and utilization of particular services and procedures associated with those diagnoses.

The coder may audit and re-file appeals of denied claims. The medical coder educates and recommends federal mandates requiring providers use specific coding and billing standards through chart audits, and he/she may act as an advocate for the provider and patient in issues of coverage and medical necessity. Certified Professional Coders, or CPCs®, are in high demand because employers know that these individuals can perform the job of medical coder with the utmost proficiency. Medical Billing and Coding Essay.