It is difficult to determine the importance of medical coding and insurance coding for your profession without some knowledge of the industry. When dealing with insurance, as well as many other aspects of the medical and healthcare industries, a little education goes a long way. Insurance, like all industries, has their own jargon used to describe processes, products, and services. These terms often refer back to the original insurance terminology that was devised to describe the industry’s processes. However, the industry has standardized on terms like codes so that terms such as premium, deductibles, co-insurance, and claims can be described in simple terms that anyone can understand.
Glossary: A list of technical terms used by a coder. When an insurance claim is processed, the coder will use the standard coding system that has been in place since insurance history began. This terminology will be based on the insurance company’s definition of what is required to process a particular medical procedure or set of medical procedures. If the coding process is done at a hospital, the hospital coder will use a standard set of alphanumeric or worded codes.
Benefits to Professionalism: Health care and healthcare professions are becoming more specialized and there is a demand for skilled medical coders. For instance, in a doctor’s office, the healthcare provider will have created a specific set of alphanumeric coding standards in which the doctor can use to assign charges to various procedures. This results in less time for patients and more accurate results when assigning charges. In fact, some medical coders choose to work exclusively as independent contractors instead of being employed by a healthcare provider. These independent contractors have no long term relationship with the healthcare provider and therefore are not bound by the rules and regulations of employment. This gives freelance medical coders the opportunity to set their own working hours, choose their own employers and work at their own pace.
Increased Education: Medical coding is an education process in itself. In order to become a qualified medical coder, one must complete an accredited program in which the student obtains at least 85% of their credits through the completion of classes in anatomy, physiology, health care law, management, accounting and business administration. It also requires students to successfully pass the Medical Coding Internship which is often sponsored by healthcare employers as an incentive to hire the best coder they can get. Students who successfully completed the internship are then placed into one of many entry level positions after completion.
Flexibility in Projects: Healthcare employers have increasingly used outside of the United States to source medical coders due to the increased ability to save money on healthcare costs and the ever changing nature of coding practices. Outsourcing the coding process allows for the employment of medical coders from overseas locations at much lower cost than could be found within the United States. Some companies have even moved to outsource this function entirely. Some individuals choose to continue working within the industry, while others explore the possibility of pursuing a job with a company abroad.
Increased Awareness of Billing Procedures: As more patients utilize the internet to find a doctor or healthcare provider, the role of medical coding specialists is increasingly being required to explain what codes mean, and when payments will be made by patients. A major portion of insurance claims now are generated online and having a thorough knowledge of medical coding practices helps healthcare providers better understand when and how to pay. This also prevents misunderstanding of medical codes which may result in additional costs to the insurance payer.
The United States has experienced a rapid increase in the number of individuals enrolling in healthcare programs in recent years. Due to these increasing numbers, an understanding of health insurance has become extremely important to all of our citizens. Learning how to become a medical coder in the united states requires that you first have the training to become certified by one of several national bodies. Once you have completed the training required by your national board, you will be able to find employment in the field by searching for jobs in either the United States or overseas.
It is important that healthcare providers keep up to date on changes in medical practice. This is essential to ensure that they are not liable for actions taken based on inaccurate and outdated coding practices. While physicians and coders must adhere to strict codes of ethics to stay on the right side of the law, insurance companies and private patients can be held liable if they do not properly update their documentation. In the event that a claim is denied due to a discrepancy between a patient’s records and the insurance company’s records, it is the responsibility of both parties to resolve the situation in a fair and expedient manner.