Medical Coding and Billing: Process and Follow-Through

Medical Coding and Billing: Process and Follow-Through

With medical billing and coding, it’s important that those engaged in the endeavor focus on developing a logical process, which involves various checks and follow- through. Doing so will go a long way to ensuring success the first time that a claim is submitted.

Not doing so can result in a myriad of complications, including delays, additional processing time and effort, and outright rejection of claims and appeals. Whether you outsource your medical coding and billing or process all forms and claims within your own office, vigilance to detail, remaining current on changes in the laws and rules and regulations, and attention to timeliness are all important.

Medical Coding and Billing Process

Process is very important when it comes to filing successful insurance claims. In medical coding and billing, adhering to process will cut back on duplication of efforts, incomplete claims, and inaccurate filings. Thus, establishing a method for working that includes attention to detail, quick access to accurate information, and quality proofing of claims before they are submitted is essential to successful billing.

It’s better to take a little longer to complete a claim and to then have it checked by independent eyes before being sent to a healthcare provider, than to have a claim returned, edited and adjusted, and resubmitted by the coding and billing staff. One aspect of this process that must always be addressed is ensuring clear and concise methods of communication exist within the billing office and with healthcare providers and insurance companies and government agencies.

Details to Consider

There are various important details that every medical coding and billing office must address. These include accuracy in terms of:

• Patient identification
• Correct ICD-10 codes
• Assignment of claim to insurance provider
• Completeness of claim

Primary reasons for claims being rejected included the four points noted above. Addressing each in a detailed manner can greatly reduce the need to correct and resubmit or appeal a claim.

Addressing Changes

Any changes in the law, insurance rules and regulations, or a health insurer’s process, policies, or restrictions must be recognized and understood. If your medical coding and billing office is always a step behind on any changes in the industry, it means that you will be subject to delays when it comes to receiving remuneration. In such cases, you’ll often find yourself dealing with appeals, and in worse case scenarios audits. Either of these situations can result in even more medical billing servicedelays, which can put financial stress on a medical practice and healthcare worker.


When it comes to processing information timeliness is essential. Included is information concerning a patient’s visit, examination, or treatment; communication between healthcare providers and the coding and billing personnel; and the proper processing of claims and appeals. Procrastination in any of these areas can result in delayed payments, rejected claims due to missed deadlines, and cash flow problems.

Benefits of Outsourcing

If you’re a part of the healthcare system devoted to offering services to patients, aspects of your business that are vital to your financial health are process and follow-through in medical coding and billing. There are benefits to keeping medical billing in-house, especially in terms of communication and access.

However, outsourcing also offers numerous benefits. It can be cost-effective to hire a medical coding and billing company to handle all of your claims. Plus, a company that specializes in this area will be motivated to work in an efficient and effective manner, since usually they won’t get paid if you don’t get paid.

Many such companies offer services pertaining to all aspects of the financial workings of a healthcare practice and work hard to make sure that you are properly compensated for all charges. These companies make it a point to properly adhere to a successful process that includes complete follow-through and a high level of success.

True to Process

It’s very important that your medical coding and billing personnel utilize a process that allows for communication and follow-through. Whether you go in-house or outsource your medical billing, keeping your process as clean and clear as possible will help to keep your practice fiscally sound.

MPMR offers the best medical billing and coding services nationwide, with expertise in a full array of medical specialties and facilities. Call us today for a complimentary consultation and review of your practice!

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