The basics of healthcare coding and billing.

Since the introduction of managed care in the 1980s as a delivery system and receiving health care in the United States’ healthcare system, it has become the principal mechanism for determining the final cost and providing reimbursement by payers. The systems and processes that allow for successful implementation of managed care have increased the complexity of healthcare systems’  workflow. Medical coding and billing are an integral part of the process of managed care. Professionals engaged in medical coding and billing are highly trained. Their success determines the level of reimbursement and compensation that a healthcare facility receives for the services they provide for their patients.

What is medical coding?

Medical coding, similar to coding in other business processes, involves the systematic conversion of medical descriptions of diseases, injuries, and procedures from health service providers and converting them into specific numeric or alphanumeric codes. These converted codes are used to communicate systematically accurately, precise diagnosis and procedures performed. Medical coding ensures ease of communication between different stakeholders in the healthcare system. In this way, all the processes that are involved in providing care are recorded and accounted for.

What are the different types of medical coding systems?

There are different types of medical types of coding systems that are used in healthcare. The kind of system used is determined by the service provider that is using them and who these healthcare codes are being generated for. These medical coding systems include the following:

1.     Current Procedural Terminology (CPT)

2.     International Classification of Diseases (ICD)

3.     Healthcare Common Procedure Coding (HCPC)

4.     International Classification of Functioning, Disability, and Heath (ICF)

5.     Diagnosis Related Groups (DRG)

What is medical billing?

Medical coding is involved in ensuring accurate payments. The produced codes are provided to relevant payers, which in many cases are health insurance companies. They use the codes to determine the types of services that were provided and ensure appropriate utilization. This process of accurate coding and subsequent medical billing results in reimbursements to healthcare service providers.

Who provides medical coding and billing services?

There are many different service providers for medical coding and billing. This is a rapidly growing industry, especially after introducing the Affordable Care Act in 2008, which increased the number of insured individuals in the US Healthcare system.

The best type of providers for medical coding and billing is determined by the size of the practice, the number of patients, the type of specialty the provider practices, and the type of organization the practice is a part of.  All organizations that provide healthcare services require medical coding and billing services. Many of these organizations have in-house departments with employees engaged in medical coding and billing. It is also increasingly common to outsource these processes to third party companies such as

Medical coding and billing are a complex process integral to a healthcare service provider to receive compensation for the services provided to patients successfully. This is a top priority for any practice or healthcare organization to remain financially viable and fuel future growth.