Medical Coding is a crucial part for revenue cycle management. Medical coding if done accurately and efficiently, it ensures that hospitals are properly and correctly reimburse for the services they provide. They play a crucial role in the revenue cycle process. Medical coding is similar to translation. A medical coder takes medical reports from doctors which includes patients condition, prescription, diagnosis and whatever procedure was performed by the doctor and turns that into a set of codes which make up the crucial part of medical claim.
What is Medical Coding?
According to American Academy of Professional Coders (AAPC), “Medical coding is the transformation of healthcare diagnosis, procedures, medical services and equipment into universal medical alphanumeric codes.” The codes are transcription from physician notes, radiologic results, laboratory or other medical record documentation.
Who is a Medical Coder?
A Medical Coder is an individual responsible for translating physicians reports into useful medical codes. They ensure all the information is coded appropriately to ensure consistency and accuracy. A medical coder is employed anywhere that provides medical services. This can include hospitals, clinics, nursing homes, treatment centers, labs. Some insurance companies also hire medical coders to work on the other side of the table to handle patients’ claims and verify the accuracy of incoming claims. Even some law firms hire medical coders to help identify billing fraud.
The critical trait of a medical coder is a strong ethical standard because the patient data they work is highly confidential. They must also have a keen eye for details, as one mistake in the code can lead to larger issues. Their work is repetitive and extremely important, hence they must remain focused.
Why is there a need to code?
What is the need to code medical reports? Wouldn’t it be enough to list the diagnosis, symptoms, and procedures and then send them to the insurer and then wait to hear which services can be reimbursed!
To answer this let’s take a simple example: If you visit a doctor for a sore throat, and present the doctor with symptoms like fever, enlarged lymph nodes, sore throat all these will be recorded along with the procedures and the medicine prescribed by the doctor. This is just an example while patients come with more complex diseases where a lot of information is required.
Over 1.4 billion patients visit in the past year according to sources, with different diagnosis. The system is loaded with data, it’s difficult to transfer a lot of information every year. This is when a medical coder allows for an efficient transfer of huge amounts of information. It also allows for uniform documentation between medical facilities. Coding is important especially for large medical facilities like hospitals.
Medical coding professionals take information from the medical records documentation and assign diagnosis and appropriate procedure codes. They then develop the insurance claim which indicates how much the insurer owes for the care and how much the patient had to be billed.
Medical coders are different from medical billers. Medical coders use classification systems to assign codes. They may also audit and re-file appeals for insurance claim denials. While medical billers process and follow up on claims.
Accurate coding of claims requires correct clinical documentation. Coders may find it difficult to apply codes if the documentation is incorrect which could result in the claim being denied by an insurer.
In the coming years, it is projected that the demand for medical coders is going to rise by 23%. The average salary of coders is based on a person’s credentials as well as the location of their work and job responsibility. The average salary of a medical coder is INR 2,56,900.
Medical coders don’t have to have a bachelors or masters degree but they must gain knowledge in physiology, medical terminology, and anatomy. To become a medical coder, one must have specialised training and certification. Many medical coding programs can be completed in less than a year. After completing a medical coding program, the next step is to take the CCA (Certified coding Associate) or CCS (Certified coding specialist) exams.
Medical coding is the big career option in the healthcare industry. Medical Coders is the highly paid job profile as far as the US healthcare industry is concerned and this practice is now spreading in the face pace across the world, creating millions of new job opportunities.
AAPC Medical Coding certification training and job oriented training teaches the fundamentals of medical coding, prepares the student for certification and helps them establish a career in the healthcare industry.