Medical Billing and Coding - Importance and Guidelines

Running head: MEDICAL BILLING AND CODING
MEDICAL BILLING AND CODING
Name of the Student
Name of the University
Author Note

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Introduction -The book (Drdmedsearch.com, 2019), is an author’s reflection where he
gives his readers an insight of medical billing and coding. These terms are useful in the
healthcare profession and all the physicians, clinicians and other health care providers. It
provides the readers about the definition of the terms “medical coding” and “medical billing”.
It also provides them with the differentiation between the two which is helpful in
understanding the terms better.in addition to this it displays about the important titbits which
the readers must know in order to succeed in their medical billing and coding profession, thus
helping them to become a professional in this job. Lastly, this book concludes by the author’s
suggestions to the professionals.
Discussion -According to the author, the profession of medical billing and coding
affects most lives because in this profession, all the healthcare providers like physicians,
nurses, office staff as well as healthcare gainers like patients and bill payers are involved. All
of them relies on them in any health related queries and bill payment methods. Due to
handling of such a big responsibility, they also have great power which must be treated with
respect and integrity. These powers should not be misused. Medical coder and billing are two
individual professions which must be handled carefully. A medical coder interprets the
documentation of the patient about his interaction with his assigned doctor. They then
determine the best suited procedure as well a diagnosis code in order to reflect the services
which were provided to the patient. On the other hand, a medical biller takes those diagnosis
codes and enters them in the billing software. The author opined that they also enter required
insurance information in the software and they hand over the whole bill to the payer or the
insurance company in order to claim the desired amount. Both the medical coder and the
biller are in constant interaction with the stakeholders in order to gain the amount claimed
properly. Billers are also responsible in providing the correct billing format to the insurance
company prior submission of the actual bill to them. Like many countries, United States also

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have certain rules and regulations in their healthcare system in order to prevent fraud cases by
the healthcare providers. They must be familiar with the basics of compliance, which states
that an individual who has introduced a program to run practice under the set of regulations
which are introduced by the United States Office of Inspector General. Another Act named
HIPAA or Health Insurance Portability and Accountability guarantees some rights to
individuals with respect to the healthcare treatment provided to the individual. Medical coder
should also be accustomed with the doctor’s language and know all the prefixes and suffixes
they are using in the codes which might help them later. This book also focusses on the
common prefix and suffix used in the codes which are necessary for the coders to memorize.
The second part of the book focuses on the requirements which the billers and the
coders need to know in their profession in order to reduce mistakes. This part describes the
rules and regulation in a detailed manner. Health Insurance Portability and Accountability
should be followed seriously. Violating it will result to non-compliance which is not
acceptable in this profession and hence is punishable. However, coding books are available in
the market which contains symbols that serve as the reminder with respect to the codes. Such
books also have symbols which helps the coders in analysing their code for being unilateral.
They also indicate whether the codes follow all the regulations or not. This book contains
symbols for males, females and other various specifications. Therefore, it can be concluded
that such books comprising with Medicare and payer website guides the professional coders
about the information irrespective with the patients when they wants to collect them from
their medical records. The author also describes about the difference between the internal and
the payer audits. Every huge organisation has an internal auditing department in which the
auditors are selected in a randomised order and they select their charts to evaluate. Such
orders mostly evaluate the under-coding, over-coding and incorrect coding and if any error is
detected they are submitted in order to claim. Another audit which is present in such