HOW MEDICAL CODING HELPS HEALTH INSURANCE COMPANIES
Whenever you or someone you know visits a clinic, needs emergency medical care or has a planned surgery, it creates paperwork and documentation that must be meticulously processed and tracked. The information that must be properly documented includes the type of procedure conducted and the amount and type of supplies that were used; these are the details your insurance provider and medical facilities need to determine payment for the medical procedure.
Medical coding takes information about diagnoses, treatments, procedures, medications and equipment and translates them into alphanumeric codes. This information comes from a range of sources, including transcriptions, medical notes, electronic records, lab results including blood work, urinalysis and pathology and radiologic assessments.
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In the following article we shall be getting a brief idea about how is Medical Coding helpful for the healthcare industry.
Importance of proper coding in Health insurance companies:
- Medical coding professionals transfer these codes from the sources to medical billing systems and patient records. Coding is an important step required to submit medical claims with insurers and bills for insurers and patients.
- Medical biller process and follow up on claims sent to health insurance companies for reimbursement of services rendered by a healthcare provider. The Medical Coder and medical biller may be the same person or may work with each other to ensure invoices are paid properly. To help promote a smooth coding and billing process, the coder checks the patient’s medical record (i.e., the transcription of the doctor’s notes, ordered laboratory tests, requested imaging studies, and other sources) to verify the work that was done.
- Accurate coding is important because it helps to prove the medical necessity of treatment provided. Documentation explains what services were provided, so suitable coders can be assigned to explain why treatment was needed. Moreover, correct coding helps to assign charges to resources used in patient care.
- Insurance companies often perform random reviews to ensure that the charges claimed are valid. Coding documentation helps insurance companies understand why specific charges were submitted.
This article discusses the importance of medical coding in healthcare facilities. It helps you get the reimbursement on time, prove medical necessity of treatment and appeal denials.