Understanding Medical Coding and Billing

Medical coding and billing professionals usually work behind the scenes, which means that in comparison with medical care providers, they do not get a lot of limelight. While many don’t mind, it is valuable to highlight how much they improve the efficiency of the healthcare system. The medical coding and billing practices that are currently in place streamline the care process experienced by both providers and patients.

A Brief History of Medical Coding as We Know It

Medical coding has its roots in 17th century England. Data about disease were collected and assigned numerical codes. These London Bills of Mortality were then used to assess the most recurrent causes of death. From their institution until the late 1830s, the bills’ greatest flaw was the lack of consistency in their terminology. At that time, British Epidemiologist Dr. William Farr instituted a uniform classification system. 

These improved bills served as the precursor to the International List of Causes of Death, which was fully realized by the 1930s. The list began to be used by the World Health Organization in its monitoring of international epidemiological phenomena, especially as the list further evolved into the International Classification of Diseases (ICD), which began in 1977 to collect disease and injury data beyond only that which resulted in death.

This change especially has expanded medical records and their usefulness exponentially, and a contemporaneous technological breakthrough made it possible. The commercially-available computer improved the efficiency of medical records and billing in a way that was desperately needed. Now search terms through databases are readily available, instead of spending valuable time searching through thick medical code books. This is not only more time-efficient, but also more cost-efficient, since new copies of such books do not need to be checked, updated, and reprinted each year to stay up to code.

The greater availability and specificity of diagnostic classifications provided by the current medical coding system allows medical personnel to provide more extensive and therefore better care. The current system, called ICD-11 since January of this year, has gone through many revisions to be as accessible and accurate as possible (hence the -11). Currently, there are over 140,000 ICD-11 codes.

How Do Medical Coding and Billing Meet?

Medical coders convert a patient’s medical experience into corresponding ICD-11 codes. They serve as translators so the billing process can be precise and does not get bogged down by medical terminology. Coders then send the codes to a medical biller, who is responsible for using the ICD-11 codes provided to create an appropriate bill. They first create a claim for the patient’s insurance company, which the latter then evaluates and returns. It is then up to the biller to determine how much the patient owes out of pocket.

This system of designating medical coding, billing, and insuring to different entities streamlines the record-keeping and financial aspects of healthcare. It allows medical professionals like doctors and nurses to concentrate on treating patients.

The Benefits of Outsourcing Medical Coding and Billing

More Dedicated Patient Care

When medical billing is outsourced to a designated firm, medical staff can focus on their patients, instead of feeling split between caregiving and administrative duties. Everyone at a healthcare facility benefits from this: patients can receive the dedicated care they need, and medical personnel can do what they do best.

Improve Customer Service

The other side of the coin also applies. If medical billing is performed by a third party and not a nurse that feels the need to race off to attend to patients, the people in administrative roles can give patients calling with non-medical questions a better experience. People calling to verify their coverage can have their questions answered in a more focused manner.

More Efficient and Compliant Claims Processing

Because all of the medical coding and billing is performed by someone dedicated to do them, outsourcing the processes saves a medical facility money and time. Everything is sure to be processed in the same way and in ways that are up to code.

Fewer Mistakes

Mistakes in the medical billing process have tremendous dividends. Sometimes they are not discovered immediately, which can cost a patient or practice thousands of dollars. The paperwork is also notoriously difficult to clean up, and the process can take years. Because designated medical coders and billers can do their work without dividing their attention between it and patient care, outsourcing medical billing yields fewer mistakes and is more efficient at protecting patient information. 

Boost Productivity

Without having to jump back and forth, separating caregiving and administrative work allows staff on both sides to be more productive. This can save a clinic or hospital a lot of money while providing better patient care. To outsource your medical coding and billing, reach out to Aspen Ridge Medical today.