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What is CPT VS ICD 10 & HCPCS Coding? Future of Medical Coding?

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All acronyms are confusing, but CPT, ICD 10, and HCPCS codes are especially so. When it comes to medical billing and coding, these three abbreviations are used frequently. So, what exactly do these codes mean? In general, CPT codes are used in physicians’ offices, and HCPCS codes are used in hospitals. They are used for medical billing and coding for everything from getting a simple blood test to having a tonsillectomy. Before you can become a medical billing and coding specialist, you will need to know the basics.


In our modern healthcare world, medical insurance is the primary payer for health care. Insurance companies use diagnosis codes to determine their reimbursement schedules. To receive payment from insurance companies, your office must know how to bill the right codes using the correct terminology. To make sure the insurance company has confidence in your practice, all your medical billing needs to be done accurately and consistently.


What is ICD-10, CPT & HCPCS Coding?

To know if they are obligated to pay, an insurance company needs to know whether or not the medical services they provided were medically necessary and, if they were, what the medical code is for these services.


CPT and ICD-10 codes are two of the most common codes used in medical billing. However, they aren’t interchangeable. Doctors use CPT codes to submit claims to insurance companies, while insurance companies use ICD-10 codes to process those claims.


The claims submission process is standardized and follows the rules established by the Centers for Medicare and Medicaid Services (CMS), the country’s largest insurer.


CMS uses the Current Procedural Terminology (CPT) codes and the Healthcare Common Procedure Coding System (HCPCS) codes to identify procedures performed, procedures ordered, and products utilized. Remember that HCPCS codes are for non-physician services; these codes are also used to report physician services if they do not fall within one of the CPT codes.


ICD-10 Codes

ICD-10 was created in 17th century England and is the oldest coding system today, introduced by Sir William Farr, an English physician, and statistician. The original ICD code included 74 categories for diseases, anatomy, and accidents. Due to its comprehensive nature, by the mid-20th century, the ICD had become the most widely used system for occupational injury and disease classification in the U.S.


The modern ICD-10 is still based on Farr’s original model but has expanded to include more than 68,000 diagnosis codes. Because it is so vast, many countries have adopted a portion of it called the “clinical modification,” or “clinical versions”, to help improve clarity and specificity.


CPT Codes

A CPT code, which stands for Common Procedural Terminology, is a five-digit numeric sequence assigned to all medical, surgical, and diagnostic procedures. The American Medical Association develops and updates CPT codes annually to use in reimbursements and gathers information about treatment outcomes to evaluate the quality of care.



CMS developed the Healthcare Common Procedure Coding System, a two-level alphanumeric system.


Level I represent the CPT index. In comparison, Level II is a separate system for coding medical products, such as prostheses and pharmaceuticals, and services, such as radiology and anesthesia. Currently, there are 17 categories, and more are being added; updates may occur as often as every six months.


Why is Medical Billing and Coding Important?

Besides providing medical billing services, medical coding has evolved into an important information tool and offers many benefits.


Medical coding is a universal language that everyone can understand, from billing to clinical specialists. At a glance, records can be cross-referenced. It takes seconds, not hours, to review a patient’s diagnosis at the emergency department, improving the efficiency of care. Even though medical coding is not hands-on care, this profession saves lives.


A paraprofessional can manage billing without the assistance of a clinician through coding. In the meantime, the doctors and nurses will be able to focus on what they do best, caring for patients, while trained administrative staff will handle billing. Payments are processed faster, and clinical resources are used sparingly, making them cost-effective for both hospitals and patients.


Healthcare professionals need a secure mechanism to share patient data across electronic health records (EHRs) and payers. In a world where healthcare privacy is becoming more sensitive, the ability to transfer this data securely is essential. Patients and providers have the right to establish privacy protections for their health information. The Health Insurance Portability and Accountability Act (HIPAA) is a United States Federal law that sets standards for protecting the privacy of medical records and other personal health information.


Despite this, extensive data are shared between insurers, doctors, nurses, office staff, and outside professionals.


In the past, insurers compensated healthcare providers solely based on the costs of their services, but that has changed now. Doctors and hospitals that perform well in today’s reimbursement system are paid more. For patients, this is a win.


Data is essential for benchmarking since it compares provider performance with industry leaders and best practices. Creating a metric tracking structure without the existing coding systems would be too costly.


Benchmark reporting is a valuable tool for consumers today, providing key statistics on hospitals, nursing homes, and physician performance. For example, patients with heart failure may benefit from providers with lower re-hospitalization rates. It gives you the confidence to know which facilities have a successful track record.


Public health authorities use coded data to analyze general health issues and monitor the disease’s prevalence among demographic groups. Agencies like WHO and CDC collect morbidity and mortality statistics. A medical journal always cites ICD-10, CPT, and HCPCS codes when reporting changing trends in death rates from heart disease or diabetes.


Public health planners rely on statistics to support their work at all levels of healthcare. Medical coding enables these tasks during a pandemic:

·        The prevalence of diseases by age

·        Analyze the causes of death

·        Utilization of hospitals and ICUs

·        Monitor the use of medical equipment, such as ventilators

·        Evaluate the outcome of the treatment

·        Providing reimbursement for audits

In near-real-time, officials can monitor and respond to outbreaks.


What will be the future of medical coding?

Investing in education pays off. Will medical coding still be relevant in another ten years? It is essential for students as jobs are being replaced by technology. 


Health experts agree that coding is an essential tool for reimbursement and research since it efficiently conveys expansive volumes of health data. It is impossible to find meaningful data without it. As a result of coding, records become more organized and easier to manage. Coding is a career that offers a future just because of its lower costs.


Medical technology is becoming more dependent on cloud-based applications for medical records, which will require more education and a more complex coding process. With a shortage of medical billing and coding specialists, more and more employers are looking for help from vocational schools that have well-trained graduates.


I will conclude by saying this

In the healthcare industry, billing and coding specialists are key players. Public health is boosted, reimbursement is streamlined, and government policies are strengthened. After a few months of studying in a full-time program at a vocational school, students can be prepared for a rewarding career with plenty of room for professional advancement.


About Scribe Align LLC

With the rise of medical billing services, there is also a rise in the use of medical scribes. What are scribes? Medical scribes are trained medical professionals who help providers with their documentation. Scribes are medical professionals who help medical professionals achieve more in less time.


Scribe Align LLC is a medical billing company located in Las Vegas, Nevada. As medical coding professionals, we manage your complete medical billing cycle, from claim preparation through reimbursement.

Here are just a few of the benefits of using our services:

·        Improve your cash flow.

·        Eliminate the need to hire an in-house billing team.

·        This will give you more time to treat your patients.

·        Improving patient compliance and collections

The challenges encountered by many providers are the complexity of the insurance industry and the numerous accounting requirements for those who employ in-house coders. By outsourcing your billing to Scribe Align LLC, you can be confident that your billing is being done correctly, efficiently, and professionally.

Differences between Physician Billing and Hospital Billing

Physician Billing vs. Hospital Billing: Understanding the Key Differences


Physician billing and hospital billing are the two types of medical billing that prevail in the healthcare industry. But what is the difference between hospital billing and physician billing?
This post will cover some essential points regarding the difference between physician billing and hospital billing, which will help you understand what factors come into play while learning about these two types of healthcare claims.


With physician billing and hospital billing, there are specific differences to tackle. For instance, physician billing is based on the percentage of the remuneration earned through procedures or a price for different services rendered. As for hospital billing, its based on the pricier reimbursement model, where the hospital charges the patients insurance plan for the services required and received.


Professional billing relates to physician billing, and institutional billing refers to hospital billing. In the healthcare industry, professionals differentiate between these terms depending on the purpose of the billing process and the services involved. The two methods, however, fall under the general medical billing process.


To highlight the key differences between physician and hospital billing, lets find out how they are used in both cases.


Physician billing: What is it?

Physician billing, or professional billing, refers to the billing process. Where claims submitted by physicians and healthcare providers are reimbursed when performing medical services or procedures on patients covered by insurance, once you decide to become a physician billing service provider, you must help the physicians or healthcare providers with claim submission and other related billing and collection tasks.

CMS-1500 or 837-P is the claim form used for physician billing. The only difference between these forms is that the CMS-1500 is a paper document, and the 837-P is an electronic document.
•    Some insurance companies, like Medicaid, Medicare, and others, only accept electronic claims as payment methods. P stands for professional configuration on the 837-P claim form, an electronic version of CMS-1500. Most of the time, expert physician billing services have more to do than institutional or hospital billing services.
Billing a doctor is an important administrative task that controls many other tasks in a medical office, like making appointments, greeting patients, registering patients, and collecting payments. 
To make sure that the organizations overall financial and operational goals are met, people who work in medical billing and coding need to know a lot about the policies and practices of physician billing. Because physicians bill insurance companies directly for patient services, a medical offices billing department relies on the accuracy of coding and claims processing to ensure that payments are made promptly. 
The organizations ability to stay in business depends on how much money it gets for each service it provides. Medical professionals can improve their ability to collect payments by learning the basics of physician billing.
•    Both inpatient and outpatient services can be billed under physician billing; both types can only be billed after patient verification.
•    All outpatient and inpatient services will be billed based on the patients insurance policy, so its important to check.
•    It is important to keep in mind that physician billing includes medical billing and medical coding as well.
Therefore, medical billers need to learn both billing and coding procedures. Healthcare professionals offices and hospitals employ medical billing and coding teams to handle everyday billing.
The process of physician billing is complicated and detailed. It is also time-consuming and requires a lot of effort and time. Scribe Align makes it easy by connecting healthcare providers with hospitals and insurance companies so they can focus on patient care instead of insurance claim submission. By outsourcing the billing process to a healthcare billing service provider like Scribe Align, you can focus on the doctors practice and patient care instead of worrying about getting paid for the medical services.

Hospital billing: What is it?

•    The hospital or healthcare provider submits claims for inpatient and outpatient services in hospital billing. For the same reason, hospital billing can also refer to institutional billing.
•    A hospital billing system also accounts for the services provided by skilled nurses. They also bill claims for medical facilities and medical claims for laboratory services, medical equipment, radiology, supplies, etc.
•    An institutions configuration is indicated by I. Hospital billing is performed using forms UB-04 or 837-I. In contrast, the UB-04 is a paper-based form, while the 837-I is a computer-based form.
•    A physicians billing is similar to a hospitals billing, except that hospital billing only deals with the medical billing process; it does not deal with medical coding. However, physician billing also includes medical coding.
•    The hospitals appointed medical biller is only responsible for billing and collection in hospitals. It is challenging to handle hospital billing as compared with physician billing.


Billing for Physicians and Hospitals: how to increase revenue?

•    Hospitals and physicians have different billing models when it comes to revenue reimbursements. But their processes have a significant impact on preventing denials and fraud.
•    Keeping track of unbilled and unmissed claims and services becomes the physician billers priority. However, the staff should be aware of any billing or coding errors when submitting claims. Technical errors can also cause mistakes for various reasons.
•    Outsourcing healthcare billing and coding services is often the best option for hospitals and healthcare providers to avoid errors and payment losses.
•    The hospital billing process is quite different from physician billing. A hospital or institutions billing function includes collection and billing.
•    As a result, institutional cases are handled only by coding experts because hospital coding is considered more complex than physician coding.

It is essential to avoid violating HIPAA privacy and security rules since physicians and hospital billing staff have access to private and confidential patient health information.
Thank you for reading about Physician Billing and Hospital billing. I am pleased to provide you with information on physician and hospital billing.

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