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Essential Aspects of the Medical Billing and Coding Process

medical billing and coding processGet to know this process if you’re considering this vital healthcare role as a career

Becoming a medical billing and coding specialist carries a lot of responsibility. This office role in a medical practice requires that you check in with each patient about his or her insurance coverage. You will also keep track of any procedures or diagnoses that come about during each visit, so that you can bill the patient’s insurance company accurately.

To help get a grasp on what you should expect the ideal claim process to look like, here are some key steps in a successful medical billing process:

  • Confirm coverage

Checking in with the patient at each visit about his or her insurance coverage will equip you to stay on top of what benefits the patient is entitled to and what procedures they may have been pre-authorized for, versus which require separate authorization. His or her caregivers will need to know this information before they can go ahead with some treatment, as will you for the claim process. Double-checking this information does not take much time, and is always worth it.

  • Know your codes

You will become familiar with some diagnosis codes, which describe the patient’s symptoms or illnesses. There will also be procedure codes to learn, which describe the treatment the patient received. In some instances you may need to do research to discover a more obscure code that is appropriate for a particular situation. CPT and HCPCS code modifiers will provide additional information about the services or procedures during that appointment. This accurate coding is what makes it possible for the insurance payer to assess whether they have the information they need to process the claim.

  • Stay organized about the insurers

It will be important to keep track of how each company prefers you to submit a claim—both how and when. You will learn to get into the habit of checking with each insurance company with which you’re not highly familiar. Developing relationships with helpful staff members at each company can also be useful and save you time in the long run.

  • Being efficient pays off

When a claim goes through the process once, rather than having to repeat steps, the claim can be paid much more quickly—which benefits your employer. For this reason it’s worth double-checking your work before you submit each claim. Being thorough and detail oriented in this way is a fundamental aspect of this job.

If you’re curious about the benefits of a medical billing and coding career, we encourage you to read more. It can be a challenging and gratifying profession in healthcare. Whatever path you choose, we wish you the best of luck in your professional endeavors!

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This post is part of the weekly blog of the Harris School of Business. We’re dedicated to supporting all our students in pursuing their career goals. Reach out to us for more information about our number of different career training programs.