The Basics of Medical Billing & Coding – What You Need to Know

Medical billing and coding are two vital aspects of the healthcare industry. They are the processes through which medical professionals receive reimbursement for their services from insurance companies, government programs, and patients themselves. Medical billing and coding may seem daunting at first, but understanding the basics is essential for anyone working in the healthcare industry.

What is Medical Billing?

Medical billing is the process of submitting and following up on claims to insurance companies, government programs, or patients to receive payment for healthcare services rendered. The billing process starts when a patient visits a healthcare provider, and the provider creates a medical record of the services provided. The medical biller then takes this information and translates it into a bill that is submitted to the appropriate party for payment.

Medical bills include information about the services provided, the fees charged for those services, and the patient’s insurance information. The biller must ensure that the bill is accurate and contains all the necessary information for the patient’s insurance company or government program to approve and pay for the services.

What is Medical Coding?

Medical coding is the process of translating the medical services provided into codes that are used to create medical bills. Medical codes are a standardized way of describing medical procedures, diagnoses, and treatments. These codes are used by insurance companies, government programs, and healthcare providers to accurately document and communicate healthcare services.

There are two main types of medical codes:

1. Current Procedural Terminology (CPT) codes: These codes describe the medical procedures and services provided by healthcare providers, including office visits, surgeries, and diagnostic tests.
2. International Classification of Diseases (ICD) codes: These codes describe the diagnosis or reason for the medical services provided.

Medical coders must be knowledgeable about the medical procedures and diagnoses they are coding, as well as the appropriate codes to use for each one. Accurate coding is essential for ensuring that healthcare providers receive proper reimbursement for their services.

Why is Medical Billing and Coding Important?

Medical billing and coding are essential for the healthcare industry because they ensure that healthcare providers receive payment for their services. Without accurate billing and coding, healthcare providers would not be able to sustain their practices or provide quality care to their patients.

In addition, medical billing and coding help to prevent fraud and abuse in the healthcare industry. Accurate billing and coding practices ensure that healthcare providers are only paid for services that were actually rendered and necessary for the patient’s care.

Medical billing and coding are crucial for healthcare policy and research. The data collected from medical bills and codes are used to track healthcare trends, evaluate healthcare policy, and conduct medical research.

Medical billing and coding are critical components of the healthcare industry. They ensure that healthcare providers receive payment for their services, prevent fraud and abuse, and provide valuable data for healthcare policy and research. Understanding the basics of medical billing and coding is essential for anyone working in the healthcare industry. It is a complex field, but with the right training and knowledge, anyone can become proficient in medical billing and coding.

Atlantic RCM is one of the leading multi-specialty medical billing companies in USA that serves 25+ major medical billing specialties. Our experts work across your practice in billing, collections and account receivables management, to help you succeed.

Get in touch with the leading medical billing outsourcing company to learn more. Call us at (469) 501-1500 or write to us Info@atlanticrcm.com