July 06, 2012
The importance of medical billing and coding cannot be overemphasized in an era where health reforms are changing the face of the health care industry in the United States. Medical billers and coders not only ensure the accuracy of the billed amount but also simplify the process of how physicians are reimbursed. The job of medical billers and coders is not limited to just medical billing and coding. They also perform many other necessary functions such as interacting with payers, managing the revenue of physicians through a systematic approach towards revenue cycle management, managing denied claims effectively, and ensuring patient privacy.
Accurate Medical Billing and Coding
The job of a medical biller and coder requires specialized and thorough training since errors can cost physicians heavily in terms of provider revenue and the way in which healthcare is delivered. Errors in medical billing and coding impact physicians negatively, in some cases the physician may be denied participation in any government affiliate program such as Medicare or Medicaid under the False Claims Act due to errors in medical billing and coding. The responsibility of ensuring accuracy and thus protecting the revenue of the physician lies with the medical biller and coder. The learning curve accompanying the health reforms is not just limited to physicians but is also encountered by their staff, including medical billers and coders.
Medical Billing and Coding Post-Reforms
The possibility of errors in the medical billing and coding industry has increased due to the migration from ICD-9 to ICD-10 codes. The latter are more complicated and expansive compared to ICD-9 codes, thus increasing possibility of errors. With almost 19% of claims being denied due to errors by insurance companies, the handling of these ‘mistakenly’ denied claims falls upon medical billers and coders who have to extensively interact with the payers in order to correct these errors.
Revenue Cycle Management
Another important task of medical billing and coding companies is revenue cycle management. The revenue cycle management process entails functions such as clinical care documentation, charge capture, coding and utilization review, billing, collections and follow-up, denial management, and data warehousing and analytics. However, there are many other pre-visit tasks that are part of the revenue cycle management that is the responsibility of medical billing and coding companies. These tasks include administrative functions, patient scheduling, checking medical eligibility, benefits verification, registration, and point of service collections.
The role of medical billers and coders in assisting providers to receive timely and accurate reimbursements has definitely increased after the reforms. The need for better medical billing and coding is being felt since a solid platform in the form of better departmental processes is needed for the higher or core objectives of the reforms to work in favor of physicians. The largest consortium of medical billers and coders in the United States, medicalbillersandcoders.com, can provide such professional departmental solutions to almost all the processes involved in medical billing and coding, revenue cycle management, EMR/EHR implementation, denial management, and consultancy.
Revenue Cycle Management