Fundamentals of Medical Billing and Coding in The US

Fundamentals of Medical Billing and Coding in The US

Medical billing & coding - when combined together- is the fundamental pillar where your whole healthcare revenue cycle management stands.

Although medical billing and coding are not the same thing, they both work together in order to process medical payments i.e. billing the patients from their insurance companies, which then proceeds to the next step i.e. paying practitioners for the treatment of those patients.
Since they are both an integral part of the medical department, their sole purpose is to handle reimbursement claims for patients. That’s why medical billing and coding are closely linked to nurses, doctors, physicians, and other important medical staff.

What is Medical Billing?

As the name implies, medical billing is the process that deals with the bills (or claims) that are sent from the practitioner’s end to the insurance companies or even to the patients. Usually, if a patient has health insurance to cover their medical bills, the bill is sent to the insurance company and they take care of it. However, if the patient doesn’t have health insurance, the bill is then sent directly to the patient.
Medical Billing

What is Medical Coding?

Medical coding is a process that starts off much earlier than the medical billing process. In fact, when a patient enters the healthcare facility (hospital, clinic, etc.) a critical process starts which is known as clinical documentation.
In clinical documentation, the system (healthcare facility) observes and notes down each and every detail of the patient which includes their diseases, the services they’re getting, the medication they have been prescribed, and the procedures that are being given to the patient. The system also records the reasons why all these services are being given to the patient.
Medical Coding

Importance of Medical Coding

Now, the whole process of recording every medical action & converting them into medical codes is known as medical coding.
Medical coding is a critical process since the whole revenue stream for practitioners depends on it. There are different types of codes that are used in the process to translate every medical process into specific codes so that the insurance companies & payers can understand what they’re dealing with. Majorly all-important coding is divided into three major categories:
  • ICD-10 Codes
  • CPT Codes
  • HCPCS Codes
Medical Billing Codes

ICD-10 Codes

The 10th edition of the International Classification of Diseases (also known as ICD-10 codes) is the coding system designed by the World Health Organization (WHO) in order to classify diseases and treatments into codes.
Furthermore, ICD-10 codes are classified into two more categories:
ICD-10-CM: This covers a broad analysis and is used in reporting all healthcare settings.
ICD-10 PCS: This classification is used only in hospital settings to report inpatient procedures.

CPT Codes

The Current Procedural Terminology (or the CPT Codes) are somewhat different than the ICD-10 codes mentioned above. Since those ones are used to code medical diseases/illness diseases, the CPT codes are the codes that are used by doctors, practitioners, physicians, etc. to describe what type of treatments and diagnoses they perform on their patients

HCPCS Codes

The Healthcare Common Procedure Coding System (also known as HCPCS codes) are quite similar to the CPT codes mentioned above as both of them deal with coding medical procedures, products, and other related services. However, HCPCS codes cover more than CPT codes. That’s why HCPCS codes are further divided into 2 categories:

HCPCS Level 1: These are similar to CPT codes and cover almost the same medical procedures & products given by healthcare professionals.
HCPCS Level 2: Everything that is not covered in Level 1 codes. These include different medical products like DME, prosthetics, medical supplies, etc.

Electronic Health Record (EHR)

Nowadays, the EHR, also known as the Electronic Health Record, plays the most crucial part in medical billing and coding. For reference, an EHR is a digitalized version of a patient’s record that a practitioner can share amongst other healthcare professionals like lab professionals, other specialty doctors, etc. Since all the records of the patient’s medical history, diseases, and treatment given to the patient are mentioned inside an EHR, it’s easy to translate all of that information into codes and then send it to the payer.

Electronic Health Record-EHR

How To Become A Medical Billing & Coding Expert?

The good news is you can learn how to do medical billing and coding on your own. There are tons of different medical billing and coding training, courses, and certifications available on the internet. You can enroll in any one of them, learn the core, and start practicing on your existing patient database.

However, instead of working on medical billing and coding yourself, it is recommended to outsource this vital procedure to someone who is an expert in handling your revenue since this process involves a lot of technicalities and there are good chances you’ll face revenue loss while processing the payments. This is why we recommend you check out our healthcare revenue cycle management services and see how we can proficiently increase your revenue by up to 23%!

Conclusion

All of the above-mentioned processes, including the fundamentals of medical billing and coding, are part of healthcare revenue cycle management. That’s why it is extremely necessary to choose the best healthcare revenue cycle management (RCM) provider so that your revenue stream can become smoother and you get the maximum reimbursements.