Medical Billing and coding services
Medical billing and coding translate a patient encounter into the languages healthcare facilities use for claims submission and reimbursement.
Billing and coding are separate processes, but both are necessary for providers to receive payment for healthcare services.
ICD-10-CM (clinical modification) codes classify diagnoses in all healthcare settings, while ICD-10-PCS (procedure coding system) codes are for inpatient services at hospitals.
ICD codes indicate a patient's condition, the location and severity of an injury or symptom, and if the visit is related to an initial or subsequent encounter.
There are more than 70,000 unique identifiers in the ICD-10-CM code set alone. The World Health Organization (WHO) maintains the ICD coding system, which is used internationally in modified formats.
CPT AND HCPCS PROCEDURE CODES
Procedure codes complement diagnosis codes by indicating what providers did during an encounter. Current Procedural Terminology (CPT) codes and the Healthcare Common Procedure Coding System (HCPCS) make up the procedure coding system.
The American Medical Association (AMA) maintains the CPT coding system, which describes the services rendered to a patient during an encounter for private payers. AMA publishes CPT coding guidelines each year to support medical coders with codingr-specific procedures and services.
Medical coding involves extracting billable information from the medical record and clinical documentation, while medical billing uses those codes to create insurance claims and bills for patients. Creating claims is where medical billing and coding intersect to form the backbone of the healthcare revenue cycle.
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The process starts with patient registration and ends when the provider full payment for all services delivered to patients.
The medical receives billing and coding cycle can take anywhere from a few days to several months, depending on the complexity of services rendered, claim denial management, and how organizations collect a patient's financial responsibility.
Ensuring healthcare organizations understand the fundamentals of medical billing and coding can help providers and other staff operate a smooth revenue cycle and recoup all the allowable reimbursement for quality care delivery.
Managing the billing process accurately is not easy as providers might face hurdles in revenue cycle management. Moreover, Net Collection Rate below 95% shows that your practice is facing troubles in the billing process. To eliminate all these hurdles and maintain your NCR up to 96%, MedsIT Nexus Medical coding Services are around the corner for you so that your practice does not have to face a loss.
Medical coding starts with a patient encounter in a physician's office, hospital, or other healthcare facility. When a patient encounter occurs, providers detail the visit or service in the patient's medical record and explain why they delivered specific services, items, or procedures.
Accurate and complete clinical documentation during the patient encounter is critical for medical billing and coding, AHIMA explains. The golden rule of healthcare billing and coding departments is, "Do not code it or bill for it if it's not documented in the medical record."
Providers use clinical documentation to justify reimbursements to payers when a conflict with a claim arises. If a provider does not sufficiently document a service in the medical record, the organization could face a claim denial and potentially a write-off.
Providers could also face a healthcare fraud or liability investigation if they attempt to bill payers and patients for services incorrectly documented in the medical record or missing from the patient's data altogether.
Once a patient leaves the healthcare facility, a professional medical coder reviews and analyzes clinical documentation to connect services with billing codes related to a diagnosis, procedure, charge, and professional and/or facility code.
Coders use the following code sets during this process.
ICD-10 DIAGNOSIS CODES
Diagnosis codes are key to describing a patient's condition or injury, as well as social determinants of health and other patient characteristics. The industry uses the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) to capture diagnosis codes for billing purposes
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