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Coding, billing and collection practices in doctor's offices

Everyone would agree that the primary function of a medical office is the care of its patients; however, to stay in practice and prosper, the practice must collect payment for services rendered. Coding, billing, and compilations are a vital part of the duties of medical office staff, and proper training and guidelines are vital to the successful fulfillment of these duties.


The billing department works closely with the coding staff in a doctor's office. In some cases, the same person performs the coding, billing and collection tasks, but these are three different positions. While some of the aspects of each job intersect with the others, they also have very specific responsibilities Unethical Medical Billing Practices.


Coding actually makes the billing process easier by unifying procedures through recognizable codes. Using diagnostic codes and standard procedures that are recognized by insurance companies, all medical practices and relevant agencies related to care, the medical coder will ensure that the insurance companies or the “commercial payer” or the Centers of Medicare and Medicaid (CMS) recognize the item billed and how the diagnosis warrants that procedure, test, or treatment.


The billing process begins at the intake of patients. It is important to obtain all insurance information before seeing the patient, if possible, so that all parties understand what each visit and procedure will cost the patient. The fewer surprises your patients have regarding payment for services rendered, the happier everyone will be. When the patient arrives and presents the insurance information, it is vital that the information provided is verified with the insurance company as active, the benefits allowed, and that the provider is currently contracted with that specific payer. Websites have misinformation, contracts expire, and benefits change, so it is very important to verify the data.


To save time, income and hassle, each procedure that is outside the normal scope of an office visit must be preauthorized well in advance or within the time limits of the specific insurance plan. Any payment owed from the patient must be discussed and collected prior to the procedure, test, therapy or treatment. Copays should always be paid before the doctor sees the patient, to avoid any problems later.


Collections of overdue amounts are the least effective form of reimbursement. The longer an invoice is overdue, the lower the probability of collection and the more money it costs the office for time and payment hours. This is the best reason of all to have an effective billing and coding staff in your medical office.


A claim denied by a commercial payer is a probable reason for an invoice not being paid on time. When both the patient and the staff have done their due diligence beforehand, this is less likely, but it does happen. An appeal by staff may be necessary with any clarification or explanation. An appeal by the patient is another possible solution, but the patient should be informed of the possibility that they are responsible for outstanding balances. While a payer agreement is usually one of the first orders of business when completing patient intake paperwork, the patient likely did not read the document carefully. Sometimes the patient they weren't feeling well at the time and were not paying attention to the document, or they were simply expecting most or all of their bills to be paid by the insurance companies. Discussing financial responsibility before a problem arises is the most effective course of action to avoid any uncomfortable and possibly emotional encounters.


Coding, billing, and collections are important to a thriving medical facility, regardless of size or specialty. Proper training, continuing education, and instruction in current changes in insurance laws, codes, or practices are imperative. Up-to-date reference equipment and materials enable these staff members to make a positive impact on both patients and the doctor's office.

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