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Medical Billing & Coding For Dummies Cheat Sheet

Working as a medical biller and coder is a challenging and rewarding job that takes you into the heart of the medical industry. To succeed, you'll need to know how to file an error-free claim, important [more…]

What’s the Difference between Internal and Payer Medical Coding Audits?

Several different kinds of medical billing and coding audits exist, both internal and those done by payers, but all refer to an independent review conducted by a different person with coding background [more…]

The Do’s and Don’ts of HIPAA Compliance for a Medical Biller/Coder

Ultimately, all employees, including medical billers and coders, within an organization bound by HIPAA are responsible for maintaining compliance to the best of their abilities. [more…]

When Unbundling Is Okay for a Medical Coder

Sometimes, unbundling is supported and a medical coder can do so. For example, if the provider performs a procedure that is listed as inclusive but does so through a separate incision, you can unbundle [more…]

What are Contractual Exclusions for a Medical Coder

For a medical coder, exclusivity may be a reference to procedures or it may relate to contractual terms. Payer contracts may pertain to the type of plan — Health Maintenance Organization [more…]

What are Mutually Exclusive Procedures in Medical Billing and Coding?

Mutually exclusive procedures in medical billing and coding fall into two basic categories. Using basic medical knowledge and common sense, the biller/coder can quickly learn to recognize potential problems [more…]

How the Operative Report Is Used to Medically Code a Surgical Procedure

As a Medical Coding Professional, when you sit down to code an open procedure, you need to see the operative report, which includes the following: [more…]

How to Use Billing Modifiers in Medical Coding

Medical Coders have found that certain modifiers are appropriate for surgical or diagnostic procedures. Other modifiers are appropriate for claims submitted for reimbursement of office visits, referred [more…]

What is the Difference between Medical Coding and Medical Billing?

Although many people refer to medical billing and coding as if it were one job function, billing and coding really are two distinct careers. Here is a brief description of the tasks and functions associated [more…]

How is a Medical Billing Claim Processed?

Claims processing in Medical Billing and Coding refers to the overall work of submitting and following up on claims. When you’re not interfacing with the three Ps — patients, providers, and payers — you’ll [more…]

What Does a Medical Coding and Billing Associate Need to Know

If you’re going to work in the medical billing and coding industry, you must familiarize yourself with three big “must-know” items: compliance (following the regulations established by the United States [more…]

How to Get a Job as a Medical Coding and Billing Associate

To score a job as a biller and coder, you must get certified by a reputable credentialing organization such as the American Health Information Management Association [more…]

Why is ICD-10 Important to a Medical Coding and Billing Associate?

As soon as you get your first medical billing and coding job — and probably even before that — you’ll start hearing about something called ICD-10, which is the 10th edition of the International Classification [more…]

What is Medical Coding?

The medical coder’s job is to extract the appropriate billable services from the documentation that has been provided. The coder is given the office notes and/or the operative report as dictated by the [more…]

Tasks a Medical Coder Does to Prepare a Billing Claim for Submission

The job of coder starts with the documentation provided by the physician. This documentation can take the form of an operative report or an office note. [more…]

How to Assign Medical Diagnosis and Procedure Codes

Upon reading the operative report or office notes, the Medical Coder must identify the illness or disease and find the corresponding diagnosis code in the International Classification of Diseases [more…]

Medical Billers Interact with Lots of Different Payers

Most providers have contracts with multiple commercial payers (basically insurance companies), as well as government payers, such as Medicare. Here’s a very brief overview of the kinds of payers and organizations [more…]

Medical Billing and Coding Employment at a Billing or Practice Management Company

One option for employment as a medical biller or coder is to work for a practice management or billing company. These companies provide various levels of administrative support, with some handling all [more…]

Insurance Companies Hire Medical Billers and Coders

You may decide that, as a medical biller or coder, you want to work in claims for an insurance company. Working in a medical claims job is one way to stretch the limits of your billing and coding knowledge [more…]

What Is Medical Billing and Coding Compliance?

Compliance — it’s such a serious word to a medical biller or coder, and for good reason. When people in the healthcare industry speak about compliance by healthcare providers, they mean that an office [more…]

How to Protect Yourself in a Medical Coding Audit

For a medical coder, protection from an audit comes only one way. If the documentation is clear, an audit is no problem. In fact, documentation is the [more…]

How to Avoid the Silent PPO Pitfall in Medical Coding and Billing

Medical coders and billers can fall victim to unidentified payers, (Silent PPO’s), which get un-contracted discounts at the expense of the provider. Normally when contracting with a network, providers [more…]

How to Prepare an Out-of-Network Medical Billing Claim

When a patient is being seen out-of-network, the medical coder or biller must verify benefits before any costs are accrued by the provider. To insure that the provider and patient both understand their [more…]

How to Bill Worker’s Compensation for Medical Treatment

Medical coders and billers have another set of guidelines which impact their work, Workers Compensation. Workers’ Compensation carriers underwrite policies that employers carry to cover treatment for injuries [more…]

How to Work with Third Party Administrators as a Medical Coder/Biller

Sooner or later the medical coder and biller will have to deal with a third-party administrator while filing a claim. A third-party administrator (TPA) is an entity hired to handle the administration of [more…]

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