Medical billing and coding translate a patient encounter into the form healthcare facilities use for claims submission and reimbursement. Medical billing and coding are separate processes, but both are necessary for providers to receive reimbursement for healthcare services. Medical billers and coders play a crucial role in revenue cycle management as their work starts from patient registration and ends with providers receiving accurate reimbursement for delivered services. Medical billers and coders are well versed with billing and coding guidelines and payer reimbursement policies. These guidelines and policies keep changing frequently, recently due to pandemics. In this article, we will discuss the role of medical billers and coders in RCM and the cost of incorrect medical billing and coding.
Role of Medical Billers
Medical billing involves preparing billing claims and submitting them to insurance carriers. Medical billers ensure that the medical practice is reimbursed the correct amount for the services that they provide patients. Once a patient visit is completed, the provider assigns diagnosis and procedure codes to the interaction. These codes help insurance companies to assess the claim and any associated coverage. Without accurate reimbursement, it is difficult for practices to provide stellar healthcare to patients. Billers are involved in various RCM processes like patient registration; eligibility and benefits verification; prior authorizations; charge entry; payment posting; denial management; correcting rejections; and account receivable management.
The Cost of Incorrect Medical Billing
As discussed earlier medical billing helps practices to receive accurate reimbursements for delivered care. Medical billers will submit claims to various insurance carriers with important information like patient info; insurance details; diagnosis codes; procedure codes; rendering provider details; billing practice details; and other. Any incorrect information in a claim will result in denied payment from insurance carriers. Examples of incorrect medical billing are duplicate billing, wrong procedure codes, and poor documentation. Medical fraud occurs when a false claim misrepresenting the facts is intentionally submitted to insurance carriers to receive higher payment.
Role of Medical Coders
Medical coding is the process of translating important medical information into simple codes for the purpose of documenting medical records and for medical billing. This standard system of medical coding allows a more seamless transfer of medical records and more efficient analysis to track the health records of patients. The revenue cycle starts with medical coding. Coders take medical reports from providers, including a patient’s condition, diagnosis, and prescription which make up a crucial part of the medical claim. The most important part of a medical coder’s job is to ensure that all of the coding and billing information is accurate and correct.
The Cost of Incorrect Medical Codes
In the healthcare sector, medical coding errors result in over 50 percent of claim denials, loss of revenues, HIPAA violations, and the prospect of legal lawsuits and hefty federal fines. Once a claim is rejected or denied, the regular revenue stream is affected, and healthcare providers are not billed on time. Not only the regular payment is impacted, but it takes time, and effort to identify and resubmit the claim and the insurance provider may then only agree to make a partial payment. Medical coding error not only results in loss of revenue but also compromises patient care and a patient has the right to file for malpractice that can result in added payment of expensive fines and legal fees.
Medical billers and coders ensure timely collection of insurance and patient reimbursements. It’s really important to have experienced medical billers and coders in your team who have your medical specialty experience. Solo or small practice owners often handle medical billing and coding operations all by themselves which could result in inaccurate medical billing. A lot of their time is utilized in administrative work which could be used for better patient care. In such cases, outsourcing medical billing operations could help.
MedicalBillersandCoders (MBC) is a leading medical billing company providing complete revenue cycle management services. We will handle all billing and coding operations on your behalf. Our specialty-wise billers and coders ensure timely collection of insurance reimbursements for delivered care. With our RCM reports, you will get a complete understanding of the number of claims submitted; the number of claims paid; and the outstanding patient and insurance amount. As we handle all functions of medical billing and coding, you can focus on the core function of your practice i.e., patient care. To know more about our medical billing and coding services, contact us at firstname.lastname@example.org/ 888-357-3226