Billing And Coding In Health Care Essay
1. Who needs to understand the billing and coding process in health care and why?
In order to understand who specifically needs to understand the billing and coding process in health care today, one must understand why it so important in the first place. “Medical coding and billing specialists play an important role in the medical services industry. They keep accurate records of patients' symptoms, medical histories, medical procedures, treatments, exam results, lab or X-ray test results, diagnoses, and treatment plans. Some medical billers specialize in coding patients' medical procedures to ensure that insurance companies bill and process them correctly.”1 According to Chapter 10, all students, health providers, and financial personnel must understand the billing and coding process in health care (Buchbinder & Shanks, p. 248). For students, the entry-level management position will, at the very least, require an understanding and grasp of the basic concepts of billing and coding.2 Health providers are the doctors, physicians, and nurses providing care for the patients and are categorized into For-profit and Not-for-profit health care organizations.2 Financial personnel are responsible for providing the accounting
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According to a CEO’s blog, “With an incredibly complex medical billing system such as ours, medical providers and organizations are bound to make occasional mistakes when coding the services provided to patients. It is this same complexity which also makes fraud and abuse easier to commit and more difficult to detect.”3 For example, upcoding can be summarized as submitting a claim for a broken wrist, when the patient was only treated for a sprained wrist. Other examples include, Phantom Billing, or billing for services never performed; and Repeat Billing, which can be best defined as billing twice for the same procedure, supplies or
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