A Typical Shift of a Medical Coding and Billing Specialist

While you may have some idea of what medical coding and billing is, a job description is typically not enough to prepare you for what you can expect while at work. The daily lives of these professionals can often be varied, but always require a certain level of organization to be successful.

Medical coding and billing specialists are a unique fixture of the medical office. These professionals are responsible for coding patient charts, recording information electronically, and processing insurance claims and payments to keep things running smoothly. While the health of patients depends on doctors and medical assistants, the health of the medical business as a whole depends on medical coding and billing specialists.

How a Medical Coding and Billing Specialist Begins Their Day

A typical day as a medical coding and billing specialist is spent processing patient data and other information. When you arrive at the office, your day will begin with a review of your emails and any new information that has come in through the medical database. After logging in, you will begin your review of daily patient charts.

Patient charts are composed of patient information such as their medical history, insurance and billing information, and any treatments they have received while at the facility. To accurately assess and submit these charts, you must have a solid understanding of insurance coverage and payment processes. A standard review of a patient’s information also involves the following processes:

• Checking the patient’s insurance coverage to determine covered benefits and any out-of-pocket expenses.
• Reviewing the patient’s explanation of benefits (EOBs) from the insurance companies. EOBs detail payments and adjustments for all charges submitted.
• Posting these payments and adjustments into patient accounts within the medical database.
• Sending statements out to patients that have balances.
• Working with patients to structure a payment plan that works for them while ensuring that the office is collecting money on services rendered.
• Working with collections agencies to pursue collections from challenging patients.
• Writing off payment balances that are no longer collectible.

A Good knowledge of the three most common diagnostic code systems is essential for completing these processes and accurately posting patient information. The code systems include Healthcare Common Procedure Coding System (HCPCS), the International Classification of Diseases (ICD-10), and the Current Procedural Terminology (CPT).

Common Medical Coding Job Complications

As with any job, some daily complications may arise and require you to take extra steps in order to ensure tasks are completed properly. In some cases, you may have a difficult time coding a chart and will have to talk with your supervisor to clarify any issue or problem you may have. You may also have to do some extra research occasionally. If a doctor or nurse doesn’t complete a patient’s chart, you will have to get in touch with them to discuss what procedures were conducted.

While some mistakes seem innocent, they can become costly for the medical office and cause payment delays. When reviewing your work you should be mindful of the following errors that medical coding and billing specialists tend to make:

• Upcoding – this occurs when patients are charged for more complicated procedures or procedures that they didn’t have done. This error is quite common and occurs when a specialist doesn’t enter the treatment data correctly or is confused by the information provided by the doctor.
• Missing/incorrect information – Claim denials can sometimes happen when information is omitted or otherwise entered into the wrong patient chart. For this reason, it is always good practice to double-check your work!
• Telemedicine errors – Telehealth services employ specific modifiers that can be hard to incorporate into regular practice. For instance, a GT modifier indicative of real-time telehealth services provided by audio/video systems is often confused with the GQ modifier that relates to asynchronous telecommunications systems.
• Using incorrect codes – A simple slip-up can lead to incorrect data entry and cause claims to be returned. It is essential to stay abreast of the latest billing and coding practices in order to avoid making mistakes!

Once you’ve attributed the proper coding to each chart, you will then complete and submit the applicable insurance forms. When sent, these forms will be processed by the patient’s private insurance provider.

Finishing Up Your Day

Once you’ve completed and submitted all of your patient forms, it’s time to end the day. When packing up to leave, it is recommended that you organize your workspace in preparation for the following day. This is especially important if you work in a small office where you are the only medical coding and billing specialist.

While this may vary depending on your work situation, most employers will expect you to work quickly to keep up with the patient flow. For this reason, it’s good practice to keep your files organized at all times. By knowing where to find charts and other information, you’ll be better prepared for meeting the practice’s workflow expectations.

Enroll At Montes HealthCare College Today

Do the day-to-day tasks of medical coding and billing specialists seem doable to you? If so, a career within the field may be a good fit! To learn more and explore our educational programs here at MHCC, simply call us at (310) 436-7000 or emailing info@monteshcc.com.