Coder Interview Billing and Coding Process

Coder Interview Billing and Coding Process

Coder Interview
Billing and Coding Process
Charging and pricing procedures in health care are different from other sectors. This is because health care is an intangible and a service sector (Adler-Milstein & Jha, 2014). In medical sector providers are competent at charging the roles in the surgery room as well as office. They are in charge of correct coding initiative (CCI) and insurance billing regulations. Compliance is an important part of their routine. The health care coding process entails approval of not only the front but also back office by medical coder. The process begins when the patient makes an appointment with the health provider or visits a hospital and completes when the reimbursement is collected from the insurance firm or the patient. In any health facility, billing and coding includes;

Coder Interview Billing and Coding Process
Patient Check-in and check-out
When the patient check-in at a healthcare center he/she fills forms, especially first timers or asked to confirm the information the physician has on file. Then the patient is requested to provide additional details like identification, insurance card, passport or driving license. All these information is recorded and stored in the patient’s database. In addition, the physician’s office gathers co-payment. In many instances, they are gathered at the point-of-service (POS), however this depends on the physician to determine if a patient should co-pay or pay prior to or after the visit. Immediately, a patient checks out, the health report is submitted to the medical coder. The medical coder interprets details of the report into useful, accurate code (Bradbury, 2015). The report also contains patient’s health history and demographic data, which are commonly known as superbill. Such a bill comprises of the useful details regarding the health services provided which includes the name of health facility, physician’s name, patient’s name, producers conducted , diagnosis codes and procedures, and other useful data. All these details are important when it comes to developing a claim (Adler-Milstein & Jha, 2014). After completion, the superbill is transmitted via a software application to the medical biller.

Coder Interview Billing and Coding Process
Preparing Claims or Checking Compliance
Medical coders use the patient’s record, universal coded text; translate medical procedures and diagnosis to bill an insurance firm. All the patient’s transactions during hospital visit, in addition to charges of the procedure are recorded; this is important when it comes to calculating the payable amount. Afterwards, the medical biller sends the amount to be paid as stipulated in the payer’s agreement with the health care facility and patient. This is the time the medical biller ensures that the claim adheres to the laid down coding and formatting standards (Adler-Milstein & Jha, 2014). The precision of the coding procedure depends on the coder; however the biller reviews the coders to make sure that the coded procures are billable. Again, the billable procedure greatly relies on insurance plan of the patient as well as payer’s stipulated standards. As such, the biller is in charge of ensuring that the bills complies to the billing standards, by following Health Insurance Portability and Accountability Act (HIPAA) guidelines and the Office of the Inspector General (OIG) (Bradbury, 2015).
Transmitting Claims

Coder Interview Billing and Coding Process
All claims are submitted through electronic means. HIPAA covers a number of parties including providers, payers among others. Nevertheless, HIPAA does not require health professionals to use electronic means to perform all transactions. However, billers can use manual claims, which leads to inefficiency. Electronic claims are time-saving and considerably resourceful and free of errors associated with humans during billing (Adler-Milstein & Jha, 2014). With regards to large payers such as Medicaid and Medicare, claims can be transmitted directly to a payer. But in cases where billers do submit claims directly to larger payers, they use a clearinghouse
Monitoring Adjudication

Coder Interview Billing and Coding Process
Immediately the payer gets the claim, it goes through the procedure called adjudication. In this case, the payer evaluates the claim while determining its validity and compliance. If the claim is valid, the provider is reimbursed. This is the phase a claim can be rejected, accepted or denied. An accepted claim does not mean the payer will reimburse the entire amount. Instead, the payer process it based on the agreed terms by the patient.
Generating the Statement

Coder Interview Billing and Coding Process
After the biller gets a report from the payer, he/she prepares a statement. Generally, a statement is a bill containing procedures the patient received. When the payer accepts to pay the hospital for the services offered, the balance is transmitted to the patient (Bradbury, 2015). Under certain cases, a biller can attach the Explanation of Benefits (EOB), which shows all the benefits and coverage under the plan. Moreover, EOB are vital in describing why particular procedures were covered and others were left out. When it comes to impacts of private and government insurers, it is of great importance to understand reimbursement, which plays an important role in the health professional’s practice. One of the main effects of private and government insurers and payers on reimbursement is coding (Bradbury, 2015). As such, it is necessary to understand accurate coding and the underlying standards. Another impact has to do with rates, which is mainly linked to Medicare system. In other words, private insurers’ or government have policies and stipulated rates that guide diagnosis and therapeutics. These are vital factors that determine the amount to reimburse.

References
Adler-Milstein, J., & Jha, A. K. (2014). No evidence found that hospitals are using new electronic health records to increase medicare reimbursements. Health Affairs, 33(7), 1271-7. Retrieved from http://search.proquest.com/docview/1545346540?accountid=45049
Bradbury, C. J. (2015). Billing issues and delayed reimbursement are key factors inhibiting medicare and Medicaid access to office-based physicians. Journal of Management Policy and Practice, 16(3), 69-77. Retrieved from http://search.proquest.com/docview/1727388783?accountid=45049

By admin in Essays on October 14, 2016