Medical coders are responsible for reviewing medical records and assigning these codes as indicated. This ensures that the health care providers they work for are properly paid for these services rendered.
Coding all of this information correctly is not easy. It requires the coder to carefully read the doctor’s and nurse’s notes to determine precisely which services the patient received.
The coder is required to understand private payer insurance policies as well as government regulations for accurate billing and coding.
Whenever you visit your doctor, his or her office personnel will bill your medical insurance provider with a statement that contains CPT codes. CPT stands for Current Procedural Terminology, and is used to describe your office visit and provide a diagnosis code of the condition that was treated.
Whether you get blood tests taken or an X-ray performed, all of these services will be represented by CPT codes on your bill.
There is a CPT code for every type of health care service provided by health care facilities and practitioners, amounting to almost 10,000 different variations.
There are another 14,000 codes for medical diagnoses. These are international classification of diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes.
In addition, there are Healthcare Common Procedure Coding System (HCPCS) Level II codes specific to medical supplies and services.
Codes are constantly changing, requiring coders to keep up-to-date on the latest rules and interpretations.
Coders are required to have more than a casual understanding of medical terminology and anatomical terms. Many employers require all their coders to hold certification as a requisite of employment.
Responsibilities common to medical coders include:
Translating medical procedures into the proper codes.
Verifying patient insurance coverage.
Managing collections and unpaid accounts through making payment arrangements and following up with patients.
Creating and managing the organization or facility's Account Receivable reports.
Working directly with insurance companies, patients, and providers to process claims.
Contacting collections agencies and determining legal options in the event of non-payment.
Coordinating with insurance companies in the event of payment discrepancies.
A medical coder must be extraordinarily detail-oriented. The coder is required to review the patient’s chart closely to determine the diagnosis and to carefully itemize every service that was provided.
Any overlooked services will not be paid to the provider, resulting in lost revenue. Should the coder input an inaccurate code, his or her employer may have to refund any over payments or face legal charges for inaccuracies in billing practices.
It is estimated that incomplete or inaccurate coding costs the average health care provider several thousand dollars a year in missed payments.
Providers run the risk of losing large amounts of revenue without competent coders.
Just about every type of health care facility will have medical coders working for them. This includes doctor’s offices, hospitals, health care systems and surgery centers.
Experienced coders may have the opportunity to work at home as a contract worker or through an employer that approves of telecommuting for certain employees.
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