Combining Medical Billing and Coding to Deliver Maximum Physician Revenue

Combining Medical Billing & Coding to Deliver
Maximum Physician Revenue

Presented By
Medical Billers and Coders

‘Medical billing’ and ‘Medical coding’ may have sometimes been used
interchangeably to mean the act of claiming reimbursement from insurance payers,
but essentially they are two separate and specialized jobs. Medical coding precedes
medical billing, and it is irreversible. While a medical biller is entrusted with far more
task than a coder, it is the quality of coding that largely decides the success of
medical billing. That is why medical coding is often termed as a ‘specialty’ by itself
while medical billing, its ‘sub-specialty’.
Medical coding is based on the descriptive narration of the medical services or
procedures done by physicians. The coder assigns appropriate codes based on the
physicians’ clinical summaries. Here, he may have to verify with diverse source
points to validate the correctness of the physician summaries. Typically, he may have
to rely on the transcription of the doctor’s notes, ordered laboratory tests, requested
imaging studies and other sources. Such verification is necessary in avoiding denial,
delay or exposure of claims to payer audit remarks.
Coder’s general responsibility is restricted to assigning CPT codes, ICD codes and
HCPCS codes to both report the procedures that were performed and to provide the
medical biller with the information necessary to process a claim for reimbursement by
the appropriate insurance agency/s. But he may also be required to audit and re-file
appeals of denied claims

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In certain cases, coder may also educate providers and recommend the
appropriate application of federal mandates and compliance that require providers
to use specific coding and billing standards through chart audits.
Medical billing, on the other hand, is a series of activities culminating in ensuring
maximum reimbursement for physicians. A medical biller job begins with filing
insurance forms in the admissible formats with the payers. He may be required to
clarify diagnoses or to obtain additional information so as to substantiate physician
claims for reimbursement from payers. Like coder, he should also be familiar with
CPT; HCPCS Level II and ICD CM codes to help him better understand the clinical
summaries.
Apart from preparing invoices, medical biller may even be involved in rectifying past
error on account of coding discrepancies. Collecting payments, making
adjustments, interpreting Explanation of Benefits (EOBs), and handling denied
claims, and processing appeals are all part and parcel of a biller’s routine.
Irrespective of whether coding and billing are done separately or by the same
individual/s, the success of physician reimbursements depends on how best they
complement each other.




While medical practices used to manage coding and billing as a comprehensive
internal function, it later started impacting their core function – clinical efficiency.
Therefore, outsourced coding and billing became the accepted practice. And, with the
US health care industry embracing its biggest billing and coding transition (ICD-10),
along with the other reforms affecting the industry physicians’ reimbursement rates
may further be impacted. Therefore, finding competent billing and RCM service
providers makes much more sense than embarking on costly in-house practices,
which may or may not yield the desired results.
Medicalbillersandcoders.com – with demonstrated ability in ensuring maximum
reimbursement for a large pool of physician practices across the 50 states in the US –
should be your first choice of billing and RCM services. Capable of maneuvering
through multi-payer and ICD-10 environment, our billing services live up to being the
most comprehensive with Patient Enrollment, Insurance Enrollment, Scheduling,
Insurance Verification, Insurance Authorizations, Charge Entry, Coding, Billing and
Reconciling of Accounts, Denial Management & Appeals and Physician Credentialing
services.




About Medical Billers and Coders
Medical Billers and Coders is the largest consortium of Medical Billers and
Coders in the united States. Our aim is to help the physician community to
reach the right expertise at the right location at the right time.

Thank You!
We support your Medical Billing Needs in All 50 states
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Combining Medical Billing and Coding to Deliver Maximum Physician Revenue

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Combining Medical Billing and Coding to Deliver Maximum Physician Revenue