Medical coder
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In medical billing, a medical coder is an individual who uses a set of published codes such as HCPCS and ICD-9-CM for reporting services and products provided by a health care provider to an insurer of the recipient of the care.[1][2]
These codes allow insurance companies to map the service provider's services to their equivalent. This process is necessary in order to be able to submit a claim against the recipient's insurance policy for any of the services or items sold to a patient. The codes are also used by local and national governments and private healthcare organizations to conduct research and gather statistical data about certain conditions, the treatment of those conditions and the outcome of the treatment.
Service providers that do not codify their claims will almost certainly not be reimbursed for their services by the insurance companies, leaving the service providers with either of three options:
- Resubmit the claim with the correct codes.
- Discard the claim, charge the patient for the loss, and leave the patient with the task of recovering the charges.
- Ignore the claim and take the loss.
There are several associations that medical coders in the United States may join, including the American Health Information Management Association (AHIMA) and the American Academy of Professional Coders.
References
- ^ Marie A. Moisio (2000). A Guide to Health Insurance Billing. Thomson Delmar Learning. ISBN 0766812073.
- ^ Michelle A. Green and JoAnn C. Rowell (2011). Understanding Health Insurance, A Guide to Billing and Reimbursement, 10e. Cengage Learning. ISBN 9781111035181.
External links
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