Proper Coding Equals Paid Insurance Claims

There are a number of reasons insurance claims remain unpaid. To understand them, let’s look at one very important aspect of the medical billing process. Proper coding. This is one of the most important, and one of the most complex, aspects of medical billing.

There is a number, or code, assigned to each and every medical condition and procedure imaginable. This procedure was put in place to standardize the industry. Although it seems to complicate things, the codes are meant to make it easier for medical providers, insurance companies, and the government to communicate efficiently. This standard language can provide an easy snapshot of an individual’s health and healthcare, and it can let the government get a big picture of public health issues and causes of death.

However, this streamlining of the industry is the foremost reason for a rejection of a medical claims. These universal numeric codes are not taught in medical school. Healthcare providers, physicians, and doctors are in the business of patient care, not billing, numeric coding, and collections. However, healthcare providers are required by law to record each and every interaction from heartburn to heart attacks and from a canker sore to cancer.

The medical billers are left to interpret, from information given by doctors and other healthcare professionals, which codes are appropriate for each ailment and procedure. Hence, they need to be able to understand reams of medical terminology and then determine if it has been accurately translated into the abstract language of numbers.

It is this very reason that proper, precise, and compliant medical coding (such as CPT, ICD-9-CM, and HCPCS) and medical coding professionals are the backbone of any practice from the largest hospitals to the smallest private practices.

View all Articles by: Melissa Clark, CCS-P