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What Does a Medical Coder Do? Starting Your Career as a Medical Coder!

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What is Medical Coding? What Does a Medical Coder Do? Starting Your Career as a Medical Coder!

The job of a medical coder is to update the patient record with standardized information for use in billing and data management. Therefore, a code must be assigned whenever a physician, nurse, or other healthcare provider provides a service. As an example, suppose you are a medical coder reviewing the medical record undergoing an X-ray.


Once the technician finishes the X-ray, they will document it on the patient’s chart. An image examination will determine whether a fracture or a sprain caused the injury, and a doctor may prescribe treatment such as a sling or cast.


Your responsibility is to assign specific codes to the medical office to bill the insurance company correctly. Therefore, analyzing medical charts and giving codes are your primary responsibilities.


Codes can aid patients when they need their insurance company to pay their claims, and proper coding can assist providers by ensuring they get reimbursed by the insurer quickly.


It’s imperative to know that medical billing and medical coding involve two different types of work. Depending on the size of the facility, billing and coding may be performed by both people or separate specialists.


While dividing the work between two jobs, the medical coder will be primarily responsible for updating patients’ health records and verifying their coding accuracy; in the meantime, the medical biller addresses claim with insurance companies and follows up on them throughout the day. To understand Medical Billing and Coding Services, check out this article, “What is Medical Billing and Coding Service, Cost, and Reason to Outsource Medical Billing?


Various titles may be used to describe medical coders. Medical coder jobs are also known as:

·        Medical coding auditor

·        Medical coding analyst

·        Diagnostic coder

·        Medical coding specialist

·        Clinical coding officer


Are there some characteristics common to successful medical coders?

Unlike other professions, medical coders do not have any “typical” prototypes. The field embraces people of all identities, ages, and experiences. Medical coders share some common characteristics that make them successful. Strong ethical standards are essential because the patient data they manage is highly confidential.


One little mistake in a medical code can lead to much larger problems. Medical coders must also be meticulous with their work. As a result, they must also remain focused because their work is repetitive yet essential. Aside from being efficient and even-tempered, their work is often tied to reaching production and accuracy goals.


Is it essential to have skills in medical coding?

There are a few technical skills for medical coders that they need, but transferable skills are also necessary. The data comes from real-time analysis of over 25,000 medical coding job posts from the past year, which revealed some of the top skills employers are looking for.


Medical coding skills to Master:

·        Health Insurance Portability and Accountability Act (HIPAA) compliance

·        Medical coding

·        ICD-10

·        Customer billing

·        Health information technology

·        CPT coding

·        Inpatient coding

·        Anatomy and physiology

·        HCPCS coding

·        Clinical documentation


Medical coders need to be proficient in the following transferable skills:

·        Time management

·        Communication

·        Multi-tasking

·        Research

·        Computer literacy

·        Problem-solving

·        Microsoft Office®

·        Analytical skills


Some of those transferrable skills might make you a promising candidate for a career as a medical coder. The list of technical skills is what a formal education teaches you, so don’t let it intimidate you.


Are you thinking about becoming a medical coder?

The information you just read has helped you gain a basic understanding of medical coding, its skills, and the vital role these professionals play in the healthcare industry. Medical jobs are expected to grow strongly over the next decade, making it an excellent option for those searching for a job in the medical field. However, when considering a healthcare career, you need to be prepared for what lies ahead.


Requirements for becoming a medical coder?

A bachelor’s or master’s degree is not necessary to prove proficiency, though it can strengthen an individual’s career. It would be best if you had a solid foundation in physiology, anatomy, and medical terminology. If you’d like to work as a medical coder, you’ll need to complete a coding course.

Several community colleges offer coding training, and online learning centers offer this service. The majority of training programs are 18 to 24 months long. In addition, the American Association of Professional Coders, a credentialing body for medical coders, offers several medical coding courses.

It would be best to prepare for the certification exam to become a certified professional coder through your study program. The certificate proves your understanding of coding rules and your ability to translate patient charts into insurance billing correctly. Coders with less than two years of experience earn the CPC-A (apprentice) designation until they are fully qualified. In addition, your knowledge of physician offices (CPC), outpatient facilities (CPC-H), or payers (CPC-P) will be tested in AAPC examinations.

Certifications for specific medical specialties are available based on the type of service rendered, including evaluation and management, general surgery, and obstetrics and gynecology. The certification status must be maintained through continuing education.

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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