How to Enter the Codes into Billing Software for Medical Billing - dummies

How to Enter the Codes into Billing Software for Medical Billing

As a medical billing professional, you have to enter the codes into the billing software after you have the patient information and the provider documentation of the patient encounter. You now have the information you need to enter the correct CPT and ICD-9 codes into the billing software. This is the general procedure:

  1. You enter the patient information into the billing software.

    This information includes patient demographics, payer information, and financial guarantor information.

    If the patient has two insurances, one is primary and one is secondary. Some patients may have more than two carriers. If so, you enter that information into the billing software, too, along with the order in which the insurance carriers should be billed.

  2. You abstract the billable codes based on what the physician documentation says.

  3. You enter the information — the CPT (procedure) and ICD-9 (diagnosis) codes — into the appropriate claim form in the billing software.

  4. You send the claim off.

    In most cases, the claim is electronically uploaded to a medical clearinghouse to then be sent to the appropriate payer. In some cases, the claim is sent directly to the payer.

    Many carriers have claims submission portals on their websites that allow providers to submit claims directly. However, because the process can be time consuming (due to having individual websites for each carrier), this system isn’t efficient for larger providers. Also, medical billing software and clearinghouse software provide code-editing services that help prevent claim rejections due to clerical coding errors — an advantage you miss if you submit claims directly.

To get the provider paid, you have to submit every single claim as obligated by the payer contract. Unfortunately, every payer seems to have different rules, and you’ll encounter thousands of little billing and coding peculiarities unique to each payer. The best way to find out about these rules and payer-specific peculiarities is to read the contract or call the payer relations line to verify submission requirements.