A brief overview of the medical coding and the health care reimbursement process.
This paper examines how health care reimbursement remains a complex and complicated issue and how, with so many health care plans available, and various clauses governing each, it is a mammoth task for medical coders and the American Medical Association (AMA) to keep abreast of continuing changes. It looks at how mastering medical coding and the health care reimbursement process requires a comprehensive understanding of all that is involved in claims submission, claims processing, compliance, coding, etc., and how physicians, patients, and medical coding professionals need to understand insurance basics, types of insurance coverage, how the different plans work, the coding system itself, processing claims, reviews, and appeals.
“Coding primarily intended to report the service provided by a physician or hospital and identify the billing and payments mechanisms associated with that service according to various insurance plans, often third party payers. Professional medical coders are billing experts who assign the appropriate procedural code for insurance claims processing. Of course, medical coding is affected by numerous factors including regulatory issues, Medicare audits and basic insurance procedures. Their role is to insure that appropriate coding procedures are met and correct reimbursements identified.”