Tuesday, October 19, 2021

Daily Activities of Medical Billers & Medical Coders

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Daily Activities of Medical Billers & Medical Coders/Working In The Industry

If you’re looking for a career with better long-term expectations, a career in the medical care field could be a good match. At now, healthcare has become the most significant career path in the United States. As a result, qualified healthcare professionals have high demand than others.

medical biller

Let’s now look at some of the daily activities performed by professional medical coders and medical billers.

WHAT DOES A MEDICAL CODER DO?

Medical coders update patient records with standard details needed for data management and medical billing processes.

If said in few words, professional medical coders start the day by evaluating their code reports. Their job seems simple: a coder studies a doctor’s report from a checkup, and then he decides the best way to translate the description into code.

For example, let’s say a medical coder analyzes a patient’s health record who visited a medical clinic for an X-ray.

After the technician completes the X-ray, they will note down the process on the patient’s chart. A doctor will then study the X-ray to identify the cause of the injury, if it’s a fracture or simply a sprain, and may also advise treatment, like a sling or a cast. After that, it’ll be a medical coder’s responsibility to study these notes using the ICD-10-CM and CPT manuals and apply the proper codes for the X-ray, the doctor’s examination, the diagnosis, and any treatment provided.

The specific codes will help decide how the medical office bills the insurance company for the patient’s visit. Therefore, analyzing medical charts and assigning codes are the primary responsibilities of a medical coder.

Medical coder’s day typically starts with logging onto the computer and opening the various applications needed to work in the job.

After that, the medical coder will check for updated patient charts. Then, the medical coder has to line up the charts and select which ones have to pick up first—medical coding training help to decide which charts are critical and which ones are not.

A medical coder’s job responsibility can differ from practice to practice. For example, a coder may be responsible for processing all patient charts in a small organization, while a large hospital might have you specialize in a particular coding area. For example, a coder may work simply with inpatient surgeries or with outpatient surgeries, or a coder might work as an auditor who checks other coders’ work for authority.

Usually, when you are starting a new role, you’ll have an opportunity to build up your coding skills.

A medical coder should become very familiar with the codes for a general office visit (99214) and common illnesses. Coders must stick to the guidelines for every code. Certain conditions, for example, have to be coded in a particular order.

The medical coder should corroborate that he transcribes the visit record accurately because each code has its guidelines and rules according to its order. If the coding is incorrect, this might result in a rejected claim, which can be a problem with the repayment.

After prioritizing medical charts, the medical coder will spend most of the day working with various coding tasks. Additionally, the medical coder will analyze medical charts, take down notes, and assist with billing.

An employer will generally expect how many charts a medical coder should complete each day because every medical practice has a specific time duration for coding reports. This time duration is typically two to five business days. That means that coders should complete their coding within five days of the doctor’s visit. 

Making these deadlines confirm that the billing and reimbursement process can move along without any problem. Medical coders have the responsibility to manage these deadlines and work in a timely, well-organized way.

If the job includes both coding and billing, an employee may want to experiment with working more efficiently.

After coding all of the patient charts at the end of the workday, a medical coder has a few tasks.

First, the medical coder should save work, log out of all computer programs, and ensure have no deleted paper-based records. Due to patient privacy and confidentiality laws, a medical coder shouldn’t leave medical records visible to any unauthorized person.

Suppose the medical coder is working in a large healthcare facility that has coders working on multiple shifts. In that case, he has to clear off the desk space if another medical coder will be working there on the following change.

Finally, if any new charts have come in at the end of the day, medical coders have to analyze and prioritize them so it’ll help to start on the next day’s work.

Medical coders must be incredibly detail-oriented. They should pick out the most critical data in the documentation and convert it into correct codes.

Here is the summary of the daily activities of a Medical Coder

On a typical day, a medical coder will perform these duties:

  • Analyze medical documents and translate notes into diagnosis codes.
  • Communicate with medical providers and insurance agencies, or other payers.
  • Communicate with medical providers to verify or get details to “code to the highest degree of specificity,”
  • Use different medical coding software and patient record platforms for work.

WHAT DOES A MEDICAL BILLER DO?

The medical biller plays a crucial role in the relationship among medical providers, patients, and insurance companies. While the medical biller is not responsible for patient care, they should understand medical terms to discuss medical bills with insurance companies and patients.

After the medical coder’s employment ends, the medical biller’s job will begin. The medical biller’s responsibility is to create precise, legitimate bills for the medical care provider’s office and send them to an insurance agency or payer without delay. It’s also the biller’s responsibility to send out and collect payments from patients.

The medical biller’s day starts with many different works. The medical biller is responsible for creating faultless, formally correct claims, checking for corrections in transaction documents, and making bills for patients.

First, the medical biller grabs the codes from the medical coder through a form or a computer program and creates a medical claim. A claim is a list of procedures, services, and costs sent from a healthcare provider to a payer to collect reimbursement for the provider.

This process seems simple but can be very complex. First, the biller should confirm that all of the codes correspond to one another. Medical claiming is like a quality check after the medical coder completes their report. The medical biller should be familiar with the current forms of CPT, ICD, and HCPCS codes for work with medical claims.

Medical billers also have to be familiar with the patient’s insurance policy to decide if the healthcare provider’s services cover the patient’s plan. The medical biller needs to confirm that every code of the claim is billable. Every insurance payer has rules to decide what can and cannot bill for under the policyholder’s contract.

The medical biller should create an accurate medical claim that covers all the above points and then sends it off to the payer.

After that, the payer does some estimation about the medical claim. Then, the payer decides how much of the bill it will reimburse the provider for and sends it back to the provider in a transaction report.

The biller then evaluates this transaction report and checks it. The biller confirms the charges and repayments match the provider’s agreement with the payer. If the transaction report is correct, the biller then processes a bill for the patient, explaining which services and procedures are covered, how much, and which strategies the patient is responsible for paying.

In addition to submitting claims, medical billers work on unpaid claims, formulate bills for patients, and work with patients to make payment plans to confirm a provider or facility does the correct payment amount.

The final part of the medical biller’s day is that of collections. Should a patient be incapable of paying for the medical services offered, a medical biller has to send them reminders and, lastly, send their bill to a collections service. The collections process varies and depends on the medical care provider’s policy.

As with medical coding, accuracy is critical in medical billing. Billing also includes time-sensitive duties since this step is to attach up to reimbursement for medical care.

Medical billers also should be detail-oriented. They have to look for any possible mistakes, so repayment happens without any delay. It means billers need a foundational understanding of the coding system used in the facility where they work.

Here is the summary of the daily activities of a Medical Biller

  • Medical billers are responsible for receiving the correct payments. On a typical day, they may:
  • Use diagnosis and procedure codes given by a medical coder to generate and submit repayment claims.
  • Analysis codes and claims to confirm they are correct and represent the level of care provided—no more, no less.
  • Communicate with medical providers, coders, and insurance agencies to work out any disagreements.
  • Work with patients to get repayment for remaining costs uncovered by insurance companies or other payers.
  • Communicate with health care providers and insurance agencies to obtain pre-approval for treatments or processes as needed.

The medical coder and medical biller should work together for the success of the health services.

Can one person manage both roles?

It’s necessary to keep in mind that medical billing and medical coding are two different careers. Some offices may have one person to do both functions, though more extensive facilities may employ separate billing and coding specialists.

When the work has two jobs, the medical coder will primarily update patient health records and verify they are correctly coded. The medical biller will work on submitting and following up on claims with insurance agencies.

Mostly, different workers manage the billing and coding tasks. That said, in some cases, someone can work as a medical biller and a medical coder.

Small companies may join the medical billing and coding positions like a standalone physician’s office or a small practice. Larger organizations, like hospitals and clinics, keep these titles separate. Generally, at most organizations, medical billers have less salary than medical coders.

But it doesn’t hurt for coders also to be proficient in billing. Having a certification in medical coding can allow billers to transition careers and increase their pay.

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Dennis L. Hernandez
I am a medical biller, a blogger and have 20 years of experience in medical billing, medical billing management, and medical assistant. My background includes positions as a clinical medical assistant, medical records technician, medical office manager, biller, and coder.

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