What is a Medical Coder?
A medical coder is not a medical biller, but medical coders need basic medical billing knowledge to competently and efficiently do their job, since both disciplines are so closely related and code-pendent (pun!)
There are over 819,000 physicians and surgeons; 2.4 million registered nurses, 77,000 occupational therapists, 182,000 physical therapists, 94,000 respiratory therapists and a plethora of other allied health professionals in the USA alone. Naturally they ALL want to get paid for their medical services and supplies provided to the public. This is where the medical coder comes into play! The medical coder gets the ball rolling by initiating the reimbursement process. The process begins by abstracting coded information from the patient's medical record into the financial system for billing.
Correct medical coding is just as crucial as correct medical billing in getting paid for services provided, otherwise, when ever a claim is not properly coded, filed, submitted, and processed it leads to denials, and this means losses for the provider. Naturally a professional business cannot prosper on losses. When medical coding firms or doctors outsource their medical coding and billing it is critical to assure the chosen individual or company is well versed in the latest coding standards and follows AHA, UHDDS, HCFA and HCHS coding guidelines, latest medical billing criteria, and uses clearinghouses to get the job done in an efficient manner.
Medical coders and well as medical billers must have the ability to read and understand handwritten physician notes and documentation and a working knowledge of at least one patient management system, along with familiarity with electronic medical records and ability to discuss and resolve claims issues with clinic staff and patients.
The close relationship between medical coding and billing is undeniable and inescapable! While they are well respected and highly regarded they often face adversities from insurance companies, such as inappropriate denials, poor payments and other obstacles and disservices to the doctors and patients that the must resolve working hand in hand with each other to coordinate their efforts. Their mutual goal is to meet patient and health insurance billing needs of doctors, clinics, hospitals, home health care service agencies, and similar businesses in the health care network. Although regarded as two different disciplines, medical coding and billing professionals work hand-in-hand to assure health care providers get paid for all procedures and materials rendered.