How does the Medical Coding Department works?


In the current synopsis of the health care industry is more complex with newer treatment procedures for various diseases and its diagnoses. This is where the Medical Coding Department helps out the Insurance service providers in converting complex medical records to universal codes taking into consideration the density of claims and similarity of diagnoses.

Pre-evaluation process

Receiving Medical Record

Precoding

Coding

Uploading completed claims

Quality Evaluation by the Client/Insurance Companies

Client Feedback.

 

WHAT IS MEDICAL BILLING?

  • This business seems to be no more than data entry and that the software makes the business work. And clients just waiting for someone to process their electronic claims..

  • WHAT IS MEDICAL CODING?

    Medical Coding is the process of converting verbal diagnosis and procedures to a standardized Universal numerical code. The details of the Medical diagnosis and procedures...

  • MEDICAL BILLING CLASSES

    The Medical Billing industry is one of the fastest growing industries in the market. In the Global market the Medical billing has shown a tremendous upsweep in the last few years...

MEDICAL BILLING FUNCTION

People from US normally acquire their medical insurance through their employer. An employer /company signs up for a particular health insurance plan..

 

 

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How does the Medical Coding Department works?

 

 

In the current synopsis of the health care industry is more complex with newer treatment procedures for various diseases and its diagnoses. This is where the Medical Coding Department helps out the Insurance service providers in converting complex medical records to universal codes taking into consideration the density of claims and similarity of diagnoses.

 

Now a day’s medical health care centres have a separate department devoted to medical billing, else the entire billing process is outsourced to medical coding and billing agencies. In case of outsourcing, the medical data are collected from the Health care centres / hospitals.
The entire process of the Medical Coding Department is as follows

 

Once the medical coder receives an approval from the hospital or the health care centre, the pre-evaluation process starts and during this process the medical coding department conducts a case study on the Client’s requirement. This study involves an individual analysis on the reports required, TAT (Turn around Time), and the strategy to be followed during the entire medical coding and billing process.

 

The scanned medical record or the necessary health data is uploaded to an FTP site by the Client or the Health care provider, which is downloaded by the medical coding department and designated to the appropriate coders.

 

Once the Medical Record is received, the Pre-Coders enter the personal information like the patient’s name, address, contact details, insurance policy number, Place of Service, Doctor’s name and other relevant personal data.

 

Once the level of service and diagnosis is estimated using the Medical Record, it is then converted to a 5 digit alpha numeric standardized Universal code. In U.S., the diagnoses used to track the diseases and its type are coded using the International Classification of Diseases (ICD-9-CM) manual (will be replaced by ICD-10-CM from 10/1/2013) and the procedures performed to analyze the diagnoses  are given a code drawn from the Current Procedural Terminology (CPT) Database. These codes are to be extracted precisely to describe the medical history of the diagnosis and procedures in a universally acceptable form; there by a careful understanding of the medical terminologies becomes important in the medical coding process

 

On the successful completion of the medical coding process, the medical financial claim is made ready and uploaded to the FTP site.

The Medical Bill, say the coded files are then forwarded to the Client or the insurance companies through the FTP site. This medical coding forms the source of the insurance claim; this data helps the insurance providers to authenticate a patient’s eligibility on the medical claim on a common universal standard.

On receiving the Client’s feedback, the medical coding department interprets the same and if required harmonize it with the original coding and improve the coding process to provide the Client with the most reliable, appropriate and consistent service.