Medical billing and coding must be noticed as they are vital to any medical facility. To achieve better patient safety, on-time payment, and efficient operations, every medical facility should be accurate in these both. Health insurance takes care of the key portion of healthcare expenses, although there is a huge demand for correct medical billing and coding services.
Medical billing and coding are considered essential because the payments for medical services provided to patients are directly impacted by this process. Therefore, no compromise can be handled with accuracy in medical billing and coding. Inappropriate and failed medical coding and billing are a reflection of bad administrative service in any healthcare facility. When reasonable medical claims management is applied, it provides better collectible revenue.
Medical coder v/s medical biller
A medical coder is an expert in decoding the procedure or service written on the document of the patient provided by a health practitioner. A medical coder also determines the correct procedure and diagnosis code to submit. Skilled and well-trained medical coder spends most of their time evaluating and accurately coding the data to ensure an error-free medical billing process.
On the other hand, a medical biller puts the claims with correct medical codes and submits the claim to the insurance company for billing. The next role of a medical biller is to be in touch with the insurance company and follow up about claim approval. If any discrepancy or return comes from the insurance company, the medical biller then approaches to patient and informs them about the same.
How important is accuracy in medical billing and coding
Medical billing and coding are all about accuracy only. If any errors or flaws are there, then it will hamper the claims approval process. Therefore, medical billing and coding accuracy are crucial to submit claims on time. Accurate medical claims have a high chance of getting approved in a short time and reduce account receivables.
Impact of incorrect medical billing
Errors in medical billing create a ruckus among patients and make them panic. It impacts patients through facing financial downtime, explaining things on a phone call for a long time, being pushed to pay extra amounts, and others. This creates dissatisfaction for patients and they will think twice before visiting.
Errors to be avoided
Inappropriate use of balance billing
Balance billing is the practice of physicians’ ability to bill patients for outstanding balances after the submission of bills through an insurance company. Physicians not bound by in-network rate agreements can bill patients for the full remaining balance.
Duplicate billing occurs when a medical services provider attempts to bill Medicaid or medicare and at the same time, the insurance company also bills for the same patient. Or when two providers get paid for the services provided to the same patient, for the same patient, and at the same time.
Under-coding and over coding
Under coding and over-coding can have a deep damage Overcoding may result in insurance companies taking higher reimbursements rather than the right reimbursement. Here, the consequences of getting detained outweigh the benefits of getting high paychecks. On the other hand, under-coding can result in the loss of revenue for medical service providers.