Medical Coding

 Medical Coding is a type of alpha and numeric code.Is the process of transforming the description of medical diagnoses and procedures into universal medical code numbers.

Medical coding is the 1st step process in the medical billing process and it involves Icd-9-CM(international classification disease-9-clinical modification) , CPT(Current procedural terminology) & HCPCS(healthcare common procedure coding system) codes.

                                                    Healthcare Cycle

Patient

                                              Þ                                                                     
Reception

Þ

Doctor

Þ

Transcription report (Audio file which is said by doctor)

Þ

Medical Coder (Of report Text file) need to coded

Þ

Medical Biller (Go for bill to payer)

Þ

Code file fill in form (HIPPA)

Þ

Payer:

*Denial (AR caller)

*Partial Pay

*Pay

Revenue Cycle Management 

Revenue cycle management (RCM) is the process that manage claims processing,payment and revenue generation.It entails using technology to keep track of the claims process at every points of its life, So the healthcare provider doing the billing can follow the process and address any issue,allowing for a steady stream of revenue.

The process includes keeping track of claims in the system, making sure payments are collected and addressing denied claims,Which can cause up to 90 percent of missed opportunity. 

RCM encompasses everything from determining patient insurance eligibility and collecting co-pays to properly coding claims using ICD-10. Time management and efficiency play large elements in RCM, and a physician’s or hospital’s choice of an EMR can be largely centered around how their RCM is implemented.

Healthcare Revenue Cycle Management
Physician/Medical Billing Companies	Hospitals
Demographics Entry/ Patient Registration Eligibility Verification Medical Coding Charge Entry A/R Follow-up Denial Management and Appeals Credit Balances Analytics and Reporting	Patient Access Scheduling and Pre-Registration including eligibility verification Registration Revenue Capture Charge Capture Medical Coding Receivables Management A/R follow-up Denial Management Self-pay follow-up

  

What does a Medical Coder Do?

It takes a good deal of education and training to become a skilled medical coder. To begin, coders must have a thorough knowledge of anatomy and medical terminology. It is also important to become familiar with different types of insurance plans, regulations,compliance and the coding community’s three critical resource books: CPT®, HCPCS Level II and ICD-9-CM along with their corresponding codes and guidelines.
 

Using code books the medical coder assigns correct codes to record the service levels for the procedures performed and to account for supplies used to treat the patient during an encounter with the physician. Proper assignment of ICD-9-CM codes corresponds with the physician’s diagnoses and completes the “story” of the patient’s illness or injury.

Medical Coding Courses :

Medical Terminology

Medical terminology courses teach students the meaning, spelling and use of technical terms that are used in the medical field. You will learn how to relate these terms to the correct body structures, diagnoses and treatments as well as become familiar with their common abbreviations and acronyms.

Anatomy &physiology

Common topics covered in anatomy and physiology courses include the basic biology of the human body as well as the circulatory, skeletal, muscular and nervous systems. Once you have completed this course, you will be able to identify the different body systems and understand how organs function.

Define:

Anatomy is the study of the body plan of animals/ humans. In some of its facets, anatomy is closely related to the Embryology,Comparative anatomy & Comparative embryology, through common roots in evolution.
Human anatomy is important in medicine. Is the identification and description of the structures of living things,
Which is the branch of biology and medicine.

                                                  Divided into three broad area:
                                                           Human Anatomy                                         
                                                           Zootomy(Animal) Anatomy.                                       
                                                           Phytotomy (Plant) Anatomy.

Human Anatomy :

The human anatomy is the entire structure of a human being and comprise a head,neck,trunk (which includes the thorax and abdomen) two arms and hands and two legs and feet. Every part of the body is composed of various type of cells.

Human anatomy is subdivided into Gross anatomy and Microscopic anatomy.

Medical Billing.

Common topics in medical billing courses include how to create and submit invoices for insurance companies and how to follow up on reimbursement payments. Students who take these courses learn how to verify that healthcare documentation is accurate and meets legal and ethical requirements.

Internships and Externships

Internships and externships provide hands-on experience for students who are working toward an associates degree in medical billing and coding. These internships and externships are usually unpaid and last 3 to 6 months.