Medical Billing and Coding: An Important Process for Patients and Doctors

By Mike Churchill

Whether you realize it or not, if you've ever been to a doctor's office or any other type of medical office, you've been involved with medical billing and coding. Most people are never aware of the standard practice regarding how medical claims are paid. The process starts with the doctor who notes on your chart what your visit entailed and what services were performed. Next, a professional with medical billing and coding training "codes" your chart before forwarding it to the insurance company. Based on the codes provided, the insurance company either pays or denies your claim.

The coding process was originally implemented by insurance companies in order to maintain practices throughout a nationwide network of doctors and other medical institutions. Coders are particularly important to medical offices because they are on the front line when it comes to receivables. The work they do can also affect what the patient pays.

Doctors and Medical Offices

After completing a medical billing and coding program, you might have opportunities to work in doctors offices or other medical offices. Clinics, public health facilities, hospitals, nursing homes and others may require the services of someone with medical billing and coding training. You might also opt for self-employment.

One goal of coding is to be as accurate as possible with billing, while ensuring the most value for the doctor's office. The billing and coding department evaluates the procedures performed, compares them with coding from the applicable insurance agency then submits claims for payment. Mistakes made during this step can cost the office revenue or - at the very least - can delay the receipt of funds.

Patients

The doctor's office is not the only one who looks to a medical billing and coding program graduate for accuracy and effectiveness. Patients are greatly impacted by the decisions coders make. Not all policies offer the same types and amounts of coverage. A medical procedure might be fully covered or completely denied depending on the way in which it was coded.

For instance, a woman might receive full coverage for exploratory surgery related to abdominal pain under normal circumstances. However, if the claim for the operation were coded for "infertility," the same surgery might be denied or paid at a lower rate.

Qualifications and Characteristics

An interest in medical dealings would be key for medical billing and coding. Because it is necessary to be familiar with the various procedures, when they might be performed and why, those who are squeamish about the human body may not be comfortable in this vocation.

Keeping up-to-date with numerous insurance company's requirements and policies is also part of the billing and coding profession. In order to receive prompt payment for the office and/or patient, the required information must be provided to the insurance company in the manner they set forth.

Those who work in this field must be certified. Be sure to seek schools that will prepare you to sit for the Certified Coding Associate (CCA) national exam.

If you're an organized, detail oriented and self-motivated person, a medical billing and coding program might be something of interest to you. With Baby Boomers advancing in age, there are an increasing number of people in need of various types of medical assistance. Now is an excellent time to enter the field.

Mike Churchill provides online marketing for Select Medical Schools, a school database that links you to nationwide campuses offering health-care training such as medical billing and coding training and dental assistant programs. Visit them at http://www.selectmedicalschools.com. © 2007, All Rights Reserved