Behavioral health organizations providing different services to patients often take insurance from those patients to help offset the cost of services received. But how do those companies ensure they get properly reimbursed by the insurance companies? Through medical billing coding.
However, medical billing coding is much more important than just getting compensation and also serves as an effective way to keep track of patient records, diagnostic tests, and results.
What is Medical Billing Coding?
Medical billing coding is the way to translate all medical services for a patient into a standardized system not just for record-keeping but for billing and insurance purposes.
How Medical Billing Coding Works
This process works for every patient and every service provided in the following manner:
- Treatment: A client receives treatment from a facility that includes tests, procedures, and other relevant information all documented by staff
- Records: A coder reviews this information and translates diagnostic notes, procedures, services, and test results into specific alphanumeric codes
- Billing: A coder submits that information to insurance companies who then process the services rendered based on the codes as well as the billing information to reimburse providers
Without proper medical billing coding, it’s more challenging to track patient information, and particularly to communicate between billing offices, healthcare providers, and insurance companies.
Why Medical Billing Coding Matters
As mentioned, medical billing coding serves two key functions:
Patient Records
The first function is to keep track of adequate patient records that are in a standardized format to be used across all healthcare practices. By using the right medical codes, information can be shared across different specialties or facilities without compromising the integrity of understanding what was provided to a patient and what the outcome was.
Billing
As the name suggests, one of the biggest functions is billing.
The right medical billing coding is what allows for treatment providers and healthcare professionals to administer services to a patient and receive compensation for the services from the patient’s health insurance provider.
However, medical billing coding can be a complicated process to understand and mistakes in a code can delay or result in failure to receive compensation at all for any treatment or services rendered by your institution.
It is important that anyone responsible for medical billing understand the finer details of the billing process for individual treatments that are provided with any associated caveats. For example:
A clinic that is providing Spravato for treatment resistant depression will need to use specific medical codes based on:
- Whether the billing provider is in network for the plan or out of network
- Whether the client has Medicare or a non-medicare plan
- Whether there are pre-approval requirements including medical documentation before administration
- Whether the billing provider is authorized to administer or whether Spravato must have a Behavioral Health Organization aspect
- Whether there is a buy-and-bill option or a REMS-certified pharmacy for procurement
In all of these, the types of codes used will differ depending on the answer, and in some cases, failing to use the right medical billing coding system or in the appropriate order can result in a billing provider not receiving compensation from an insurance company.
Medical Billing Coding Consultations
Hiring the right staff goes a long way toward ensuring you have qualified individuals who can handle medical billing coding on your behalf. With C4 Consulting, we provide staffing consulting, HR consulting, healthcare staffing consulting services to connect you to qualified individuals in your area.
Moreover, we also offer a combined 550 years of experience in the field of behavioral health consulting with a track record of success in 47 states and 13 countries. We bring real world experience to the private and public sectors to offer innovative solutions not just to staffing needs but to a greater understanding of key questions to your business success like “What is medical billing coding?”
When you reach out to C4 Consulting, you can ask questions like these and schedule consultations to get answers. Our team of 25 seasoned experts are here to encourage a deeper understanding of medical billing coding, how it works, why it matters, and who to use it to your advantage.
We can help:
- Entrepreneurs
- Investors
- Individual practitioners
- Small group practices
- National provider networks
- Government agencies
With our full service solutions you are empowered to use the right medical billing coding strategies to sustain your success. Reach out today to schedule your consultation.
