Revenue cycle, the foundation of every hospital or medical practice, includes the administrative and clinical tasks that are performed. Like any other company and industry, the healthcare sector also depends on efficient financial resources to manage operations properly. Strong and seamless revenue management ensures that healthcare practitioners, from doctors to nurses, are compensated well and all payments of rent, equipment, and utilities are being done on time.
Medical billing and coding are the two most important factors of the revenue cycle that help form a medical claim that ensures that patients and insurance providers provide payments for the services rendered by a medical practice. Patients, or insurance companies, pay medical claims and help to drive the financial operation of medical practice.
The revenue cycle process starts with patient registration to the hospital or health care settings and ends when the medical practice gets full payment for the services provided to the patient. It may take weeks to months for a medical practice to get reimbursement because of submission of the claim depending on the patient’s illness to diagnosis, treatment, and selection of medical codes, and many times the claim denials play a vital role.
Medical coding is a career with excellent opportunities and a promising future. Because of the medical advances, aging of the baby boomer population, increase in chronic diseases health care field is growing at a fast pace. The world is moving towards an internationally accepted standard of practices in reimbursement, payment, and treatment.
The rising demand for healthcare providers is vast, ranging from medical billers to coders/chargers who support hospitals and Physician based services. Every year, an enormous pool of talented, English-speaking professional graduates with an ambition to become a medical professional, Medical coding is a good career option for such students.
It is a process where an expert coder will form a ‘super-bill’ and go through all the clinical documentation, medical transcripts, and records so that appropriate codes can be selected and applied. The payments or reimbursement that a hospital receives solely rely on selecting accurate codes for the services rendered to the patients. The regular updating and revision of the codes turns out medical coding to be a challenging task. Every year some of the old codes are removed, and new ones are added, and certain modifiers further specify or change any procedure or service performed by the Physician.
A medical coder must be skilled and knowledgeable to identify and assign the correct codes and modifiers as per the documentation. The medical codes are the translation of diagnosis, testing, procedure, and prescription into alphanumeric codes. The three fundamental coding systems used in the healthcare industry are:
- International Classification of Diseases (ICD)
- Current Procedural Terminology (CPT)
- Healthcare Common Procedure Coding System (HCPCS)ICD-10 Codes
ICD-10 Codes
The essential document that defines the symptoms of the patient because of any illness or injury is the ICD code, also known as the ‘Diagnosis code’. ICD codes aim to determine and address the global trends and statistics of different diseases and ailments.
ICD-10 codes mean the 10th revision of codes by WHO (World Health Organization) on the signs, symptoms, external causes, social causes, and findings of an illness or injury. It enlists over 70,000 disease codes and will be replaced by ICD-11 from January 1, 2022. ICD codes ensure that a patient receives proper treatment and is correctly charged based on the service he/she receives.
HCPCS/CPT Codes
HCPCS codes are a collection of standard codes that are used to define medical treatment, diagnosis, testing, supplies, and other services. The HCPCS codes help to fulfill the claim submission process to the insurance companies. Doctors, physicians, and insurance companies use HCPCS codes.
HCPCS codes comprise two sections, Level I involves CPT codes which are five digits, and Level II that includes products, services, and supplies that are not included in CPT. Level II codes are alphanumeric codes and include a letter and then four numeric digits.