Certified Coding

Medical coding and billing are often lumped together as one job. However, a certified coder is a separate person than a professional biller. A coding specialist handles the details of placing exact codes on the claim so that the physician office enjoys maximum reimbursement. In addition, the qualities of an ideal biller are different than those of an expert coder. Both coders and billers must be familiar with the necessary coding protocols, such as ICD-10, CPT, and HCPCS.

What is the Difference between Coding and Billing?

A certified medical coder is responsible for reading medical files and notes of doctors and providers, translating the services and diagnoses, and assigning relevant codes for insurance claims. A medical biller submits the claims to various insurers, private and government entities, and follows up on denied claims. An effective biller also must be a good communicator, be somewhat assertive, and be able to negotiate with others to handle disputed and denied claims.

 

Using a certified coder will help improve your collection rate, reduce time to receive payments, and boost cash flow. A medical coder should not have to deal with telephone calls and dealing with insurers. To avoid these issues, the billing specialist steps in and works as the middle person to make the flow easier for everyone. A dedicated biller reduces the number of denied claims, as well as the time it takes to receive payments.

What Makes a Good Coder and Biller?

Regardless of which professional you hire, there are a few things to keep in mind when you hire these professionals.

 

  • Experience is a plus – The coding or billing professional you choose should have experience in your specialty. If you have many patients on Medicare, it helps to have a coding professional who is skilled with codes that suit Medicare guidelines. If you have a dermatology practice, your billing specialist should have expertise with the diagnoses and terminology of this field.

 

  • Certification – A coding specialist should be certified by the American Academy of Professional Coders (AAPC) or the American Health Information Management Association (AHIMA). This ensures that you hire someone that meets a standard of knowledge that will benefit your practice.

 

  • Skills – Certain skills make the coder better. These include knowledge of codes, regulations, and terminology. In addition, the coder should have good communication and decision-making skills. Ask your potential coder how she would handle missing information in a chart, as well as how the biller would handle a rejected claim.

 

  • Deadlines and metrics – You should know what kind of turnaround to expect with your medical coder. This means how many charts can be code per hour, and how quickly the medical biller can respond to denied claims.

Outsourcing Billing and Coding

 

Outsourcing doesn’t have to mean you are not in control. With MPMR Medical Management, we offer you the best of both worlds. We manage your medical billing and coding while you maintain full transparency in your practice performance. We help you with financial opportunities so you can enjoy a healthy revenue cycle.

In addition, we help you enjoy affordable and predictable percentages of collections. You can view at a glance the updates of your practice and have full access to all computerized data at all times. We offer flexible billing and coding packages so you can decide what is best for your practice.

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