Medical CodingMedical coding experts have a key role to play in the medical billing process. Whenever a patient is provided health care in an ambulatory surgical center, outpatient facility, or physician’s office, the healthcare provider should document the care provided. The coding professional would summarize the information available in the documentation, allot the appropriate codes, and develop a claim to be paid, whether it is by a patient, commercial payer, or CMS.

Here are other reasons why the job of a medical coding specialist is so important:

  • Assigns Suitable Charges – The process enables assignment of charges to resources that have been utilized in patient care. Narrative text is matched to a code with a fitting charge.
  • Establishes Medical Indispensability of Treatment – Coding helps to confirm that treatment is medically necessary. Supportive documentation would elucidate what kind of services were provided. This would facilitate assignment of appropriate codes to elucidate why treatment was required.
  • Enables Insurance Reviews – Insurance companies frequently carry out random reviews to ensure the validity of charges. Supportive coding documentation enables insurance companies to comprehend why particular charges were submitted.
  • Provides Precise ReimbursementMedical coding is the chief source for precise service reimbursement. Codes are collected together to make the insurance payer aware of patient treatment provided so that compensation can be made.
  • Assists with Appeal Denials – In certain situation, payers reject medical claims if they believe treatment was not required or that the claims were wrongly coded. Health care providers have the chance to appeal the compensation denials by putting forward supportive coding documentation that elucidates why particular codes were allotted for compensation.
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Natalie Tornese

Solutions Manager: Medical Billing, Coding and Collections at Outsource Strategies International
Natalie Tornese joined the MOS team as a Solutions Manager in October 2011. Due to the growth of MOS' Medical Billing and Coding Division, Natalie became the most recent addition to MOS. She has twenty years of hands on background in healthcare. Starting as an EMT in New York City, she has since specialized in medical billing and revenue cycle management serving a diverse range of practices and specialties.