Medical coding is a specialized profession within the wider field of healthcare administration. Professional medical coders review the documentation contained in patients’ medical records, then they translate the written documentation into universally accepted, industry-standard medical code. These codes are used to submit claims to third party payers, and to gather statistical information, both by tracking incidents of specific diseases, and by discerning developing trends in treatment protocols. Accurate medical coding is essential to the healthcare industry. It is how claims for payment are reported for appropriate reimbursement of provided medically necessary services.
In Revenue Cycle Management industry, mainly three codes sets are used to describe any medical encounter/visit.
When you visit your doctor, your medical insurance provider will receive a bill that contains CPT code (CPT stands for stands for Current Procedural Terminology) for the office visit and a diagnosis code for the condition treated. If an X-ray is performed or blood is taken, those services would also be represented by CPT codes on your bill.
Medical coders work in every type of health care facility, including doctor’s offices, surgery centres, hospitals and health care systems. Some experienced coders have the ability to work at home through an employer or as a contract worker.
Coding is extraordinarily detail-oriented work. The coder must carefully review the patient’s chart to learn the diagnosis and itemize every service that was provided. If a service is overlooked, the provider will not receive payment for it. If the coder chooses the wrong code, the provider may have to return any excess payment or face legal charges for over-billing.
Codes change constantly every year, so coders must keep abreast of new rules and interpretations. A solid understanding of medical terminology, including anatomy, is also required.
In India, Medical coding industry comes under category KPO (Knowledge Process Outsourcing) which is considered comparatively more respected than BPOs (Business Process Outsourcing) considering the fact that KPOs need more qualified and skilled workforce as compare to BPOs.
Earlier, work from home was only an option for top IT professionals, but this opportunity is now also available for coding professionals as well, especially for certified coders who prefer to work from home due to some contingency. However, work from home requires stringent HIPAA compliance, significant work experience, strong work ethics, and discipline. As to perform medical coding, we just need a computer with window 7 preferably, a good internet connection, required code books (CPT, ICD, and HCPCS), and other online coding applications like EncoderPro to check CPT bundling issues by using Correct Coding Initiative (CCI) edit and Local Coverage Determination (LCD) for state wise payable and definitive diagnoses codes.