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Medical Billing: Which Terms and Codes Are Important?

As a member of the healthcare industry, it's vital to be aware of medical terminology and coding. These codes translate a patient’s treatment and billing details into a language that is useful for claims submission and receiving reimbursements in return. Codes are valuable, but understanding what corresponds to them is more important.

Medical coding is all about the information that you will include in a bill.

The coding process is more generic. It starts with patient registration and ends when the service provider receives the full claim amount for services to a patient.

What is Medical Coding?

Coding starts as soon as a patient registers at your front desk, and it concludes with the collection of claim bills. Intermediary steps such as entering the patient’s data, information, medical history, diagnosis, treatment, and medication all fall under coding, and these services have unique codes.

Coding entails a complete and accurate process of documentation for medical billing. 

Service providers will use clinical documentation to justify their claim. It's important to keep in mind that any service provided to the patient in which you forgot or omitted a code can result in a complete claim denial or an outright write-off.

There are several types of codes you should consider like ICD-10 codes. This has two codes: ICD-10-CM (a clinical modification) codes for diagnostic procedures, and ICD-10-PCS (a procedure for coding system) in-hospital process.

Diagnosis codes are fundamental in knowing the patient’s condition. There are 70,000 or more unique codes in ICD-10-CM alone.

In this section, we will review coding errors:

Not Enough Data

This represents your failure to provide accurate coding to substantiate your claim, which may cause the rejection or denial of your claim.

This can be the result of your employee not linking a code properly (e.g., Current Procedural Terminology (CPT) or Healthcare Common Procedure Coding System (HCPCS) code).

These errors can also occur if physicians do not provide the correct details of the diagnosis.

Up-coding

This happens when the patient complains about an overbilling for an expensive procedure in contrast to what services they required.

Telemedicine Coding Errors

These deal with healthcare services that you may have provided to patients in different or multiple locations. This segment requires attention to detail to raise a legitimate and accurate claim for insurance processing.

Missing or Incorrect Information

You can rectify these mistakes by accurately reviewing all fields like the patient’s name, birth date, insurance coverage details, and treatment dates. These details have different codes, and you must double check them before submitting any claim.

Incorrect Procedure Codes

This can entail a simple typing error or the entry of an incorrect or wrong code.

Professional and Facility Codes

Professional codes include the names of physicians and other clinical services. Facility codes derive from the costs and overheads for offering healthcare services. They also entail equipment, supplies, and other technical aspects provided during the patient visit.

Front-End Medical Billing

This process outlines the patient’s financial liabilities for your services.

Superbilling

Health care providers or practices will create a superbill, an itemized form that details the services provided to a patient, in order for the patient to be reimbursed directly from their health insurance company.

A superbill will include details like information about the service providers, doctors, the patient’s complete details and their full medical history, and insurance cover reference.

Conclusion

In order to prevent claim or reimbursement losses, hospitals and other healthcare centers should avoid errors in the billing process and input the right codes corresponding to their services.

Let us work with you to implement the right strategies to prevent medical billing errors in the first place. Our expert consultants will review your reports, trends, industry changes, and policy updates to provide your business with the right feedback and solutions to improve your entire billing process. To learn more about our commitment to excellence and performance for medical practices and healthcare providers or for questions regarding our tailored revenue cycle management solutions or other medical billing services, connect with us today.

References

https://www.m-scribe.com/blog/medical-billing-and-coding-terminology-you-should-know-u-z

https://www.gebauer.com/blog/medical-billing-and-coding-errors

https://www.nationalfamilyplanning.org/document.doc?id=655

Questions?