Medical Billing a Healthy Part of Modern Medicine

Medical billing is the practical management aspect of medicine and the way the healthcare provider gets paid. Without a good medical billing and coding foundation to base the billing of a practice on, the practice will cease to exist from lack of revenue.

In legalese, the “face-to-face contact between healthcare professional and an eligible beneficiary” is known as “an encounter.” For every such “encounter,” there is a specific code. These codes exist for the sole purpose of identifying for the payer what they are paying for. The services rendered codes (CPT) must match the diagnosis code (ICD) for the payment to be deemed necessary and just.

CPT medical coding books contain procedural terminology, while medical diagnosis codes are found in the ICD-9-CM codebooks. The medical billing and coding must be determined from a mind-boggling combination of three coding systems with over 10,000 separate codes which are updated yearly and various codings are changed or updated throughout the year.

Incorrect coding, using outdated coding or repeatedly turning in medical billing claims without proper medical necessity and documentation, will result in the reimbursement of the patient encounters being denied and bring the revenue for the practice to a screeching halt.

Good medical billing is worth its weight in gold and if you’re not already outsourcing your medical billing to the pros that can get you the maximum returns on your claims, look into outsourcing your billing today.

View all Articles by: Melissa Clark, CCS-P