Two functions of a healthcare organization that prove to be very vital for its operational and financial success are - medical coding and medical billing. Although professionals in medical coding jobs and medical billing jobs don’t serve the patients directly, they do interact with patients and handle a wide range of responsibilities in the healthcare facilities. A typical day of a medical coder or biller may include interacting with patients, physicians, nurses or health insurance providers. They ensure that they record all the patient information thoroughly and at the same time secrecy of the information is maintained. People, who wish to get into these jobs, have some wrong notions about medical coding and billing. Medical coding = medical billing : One myth about these jobs is that medical coding and billing are the same. No, both these professions are different and need different skills sets. It is true that both medical coding jobs and billing jobs require understan...

For the people in medical coding jobs, it is very critical to distinguish between an established patient and a new patient to code accurately. To do appropriate Evaluation and Management (E/M) coding and adhere to the coding compliance for timely reimbursements, it is necessary to understand the difference between a new patient and an established patient. Established Patient: According to the CPT guidelines, a person who has received a professional service from a physician or healthcare professional of the exact same specialty and who belongs to the same group practice, within the past three years is an established patient. For the new entrants into medical coding, it is difficult and confusing to distinguish between an established and new patient, but it is very important to learn this. To understand this better, one has to know what a professional service is. For the purposes of E/M code selection, the CPT recognizes a service as professional service if they are ren...

Anyone who is in the field of medical coding aspires to gain at least a couple of certifications that show his or her expertise. After a couple of years in the medical coding jobs, one can understand the nuances that have to be mastered to continue in the field along with the certifications that add value to their experience. Like any exam, the medical coding certifications also require proper preparation to be able to clear them. Though you may feel that you are already experienced in the field and have been dealing with these things for years, there will be still room for preparation.Here are few tips to help you clear your certification exams: Get hold of the right book: If you are attempting the AAPC credentials, then you have to follow the American Medical Association’s CPT version. It is even better if you can get the American Medical Association’s Professional Edition of CPT for its color and pictures. Bookmark: Forget the strategy you followed in the early yea...

Insurance eligibility verification is a very important process that has to be performed most diligently to avoid any unpaid medical bills or medical claim rejections and denials. It is not a simple process of cross-checking or double-checking the data. With hundreds of insurance providers with plans that are updated frequently, it is an onerous task to check the insurance eligibility of a patient. This coupled with the fact that most of the healthcare facilities lack manpower and time to verify the details, causes many insurance claim denials. One of the best possible ways to mitigate this risk is to outsource the medical billing responsibility of a healthcare facility to companies like Avontix that provide the best medical billing services in Hyderabad. When a healthcare facility partners with a medical billing company , it saves its time, manpower energy and money. Healthcare facilities in the USA should opt for offshore medical billing companies because they are affor...

Medical coding and medical billing are two of the most vital segments of the healthcare system in the USA. To maintain patient safety, quick payments for treatments provided and effective operations of a healthcare facility, both of medical coding and medical billing are needed. These two require professionals who are skilled at reading, understanding, recording and tracking critical medical information at a quick pace and at the same time maintaining confidentiality. But, why and how are these two fields important for the healthcare industry? Let’s see how medical billing and medical coding play an essential role in modern medicine and medical industry. Medical coding is all about patient care: Medical coding jobs require taking information related to diagnoses, treatments, procedures, medications and translating them into alphanumeric codes. All this information is collected from a wide range of sources that include physician notes, transcription reports, electronic reco...

The healthcare industry is a unique business that is different from other businesses as it deals with not a single transaction but a procedure starting from the appointment of a patient with the physician and ending with the patient’s account closure. Managing a healthcare facility is a tremendous task which includes vital matters like insurance verification, medical coding, medical billing and collections. Let us take a look at some of the challenges faced by the medical billing industry. Claim rejections: According to recent studies more than 20% of claims submitted are rejected. And more than a quarter of these rejected claims are not submitted again. If we think about the reasons for claim rejections, we can find two major answers: claims are not received by the insurance payer; insurance payer denies the claims. Usually, the payer denies the claims when there is a defect in the claim with respect to incomplete information or lack of support for the bills. Denials no...