Medical coders are an essential part of your financial and administrative team. Whether you have medical coders in-house or outsource your medical coding, you need experienced medical billing specialists to help you submit clean claims for payment. But what does a medical coder do? Here is what your practice needs to know about the role of medical coders.
Medical Coders Clean and Submit Claims
The primary responsibility of medical coders, also called medical billing specialists, is to prepare and submit claims for payment. Medical coders check the diagnosis, procedure, and service codes recorded by providers to ensure they are accurate and complete. They also transform chart notes into additional codes, if needed. Then, a medical coding team aggregates the codes that describe an office visit and submits them to the patient’s insurance company for payment. Medical billing specialists also use your practice management system to develop a claim edit library. A claim edit library is a repository of business logic used to fix claims before they go to the clearinghouse to avoid denials. Medical coders use claim edit libraries to check new claims against a sophisticated rules engine and flag any potential errors. With a Practice Management system like NextGen, you can even automate the process of checking claims against your claim edit library.
Medical Coders Work Claims Denials
Even with a strong medical coding team, claims denials happen. Medical coders work on denied claims to identify the reason it was denied and fix the problem. Claim denials happen for several reasons, including inaccurate patient information, change of insurance, missing documentation, and coding errors. Medical billing specialists may need to work with providers, patients, and payers to resolve denied claims. As a result, your medical coding team needs excellent communication and collaboration skills.
Medical billing specialists can also keep track of denials over time to identify patterns and areas for improvement. NextGen’s EHR and EPM systems can help with customized reports and dashboards. For example, TempDev’s Revenue Cycle Dashboard NextGen EPM Report lets you track accounts receivable and claim denial statistics in one place.
Medical Coders Stay on Top of Changes in Coding Languages and Rules
The world of healthcare is constantly changing. As new procedures, devices, and drugs are developed, practices need new medical codes to be able to bill for them. Medical billing specialists stay on top of these coding changes to ensure your practice submits accurate, error-free claims.
There are three main sets of codes used in health care:
- International Classification of Diseases (ICD): These codes are developed by the World Health Organization. They identify diagnoses, including disease or injury severity and origin.
- Current Procedural Terminology (CPT): These codes are developed by the American Medical Association. They identify services and procedures physicians and other providers perform during visits to your practice.
- Healthcare Common Processing Coding System (HCPCS): These codes are developed by the Centers for Medicare and Medicaid Services. They identify medical devices, equipment, supplies, and transportation used by patients outside a physician’s office.
The ICD coding system is updated regularly. While ICD-11 has been released, payers and practices continue to use ICD-10 to classify diagnoses. For CPT and HCPCS codes, new procedures, services, and devices are added on a rolling basis. For example, the American Medical Association developed new CPT codes for administering the COVID-19 vaccine. Your medical coding team will help your practice stay on top of coding changes to ensure prompt payment and accurate reporting.
Medical coders also keep track of changes in documentation and coding requirements from payers. Payers might update previous authorization rules, increase documentation needs, or change preferred coding methods throughout the year. Your medical billing team can ensure these changes are incorporated into your billing processes to prevent denied claims.
Medical Coders Improve Your Revenue Cycle
Your practice’s revenue cycle is the step you take to move from patient visits to payment. A dedicated team of medical billing specialists can help your practice increase revenue and reduce payment lags. Medical coders help ensure that claims match payer requirements before they are submitted. This reduces costly resubmissions and denials, improving your profitability.
Medical coders are also experts in using your practice management system to streamline your revenue cycle. They have a broad view of EHR coding practices that can help them identify areas for improvement in provider coding and office visit workflows. Medical billing specialists can also flag documentation requirements or common coding errors that lead to claims denials. With this information, medical coders and providers can work together to find solutions that do not increase provider burden.
Many medical billing specialists are also familiar with medical billing software automation processes. When you work with third-party developers like TempDev, your medical billing team can set up your practice management system to batch submit claims overnight to reduce strain on your system. They can also automate claims checks against your claims library to flag potential errors.
For small practices, claims volume may not warrant a full-time medical billing specialist. For these practices, outsourcing your revenue cycle may be more efficient than hiring a medical billing team. Revenue-cycle management companies can significantly boost your payments, more than covering the cost of the contract.
How TempDev Can Help Your Practice with Medical Coders
TempDev can help your practice streamline the revenue cycle with medical coding tools, training, and reports. Through TempBill, TempDev also offers temporary medical billing support or complete outsourcing of your medical billing processes. Call us at 1888.TEMPDEV or use our contact form to connect with us for your medical coding needs.