Summary: Coder Interview

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Coder Interview
Hospitals and doctors’ offices all have different methods for billing. Their differences start with the clearing house they use for this process. The coders work is based on the information they received from the office like insurance information, diagnosis codes and authorizations for certain studies. The coders job depends on the information he receives from the office. An excellent job can be done if all information is complete and the results will be seen in paid claims. This interview is based on the information obtained by the biller of a health care provider and how the process of accurate billing starts. Steps like information received from the providers office, billing with proper ICD 10 codes based on CPTs codes and …show more content…
This information containing doctors’ visits, procedures and diagnosis codes. For protection to the patient’s privacy everything in health care is coded. The two-main code sets a biller usually uses are called CPT and ICD codes. Recently the ICD codes were change from ICD 9 to ICD 10. CPT codes are usually used for medical, surgical and diagnostic procedures and ICD 10 codes are used to classify diagnoses, symptoms and health conditions (Goldsmith, 2014). Once this information is received information is put in the clearing house system and its sent away. Unfortunately, billing can get delay if proper information is not received form the providers office. An example of these can be uncomplete demographics, wrong ID or insurance information, missing ICD 10 codes for the visits. It actually depends on the providers office and the information they are obtaining from the patients, also the information the doctor is putting in the patients charts for the biller to be able to perform his …show more content…
Doctors need to work in conjunction with the billers. Paid claims is what doctors want for their offices, they want to avoid further additional documentation for procedures and visits to be sent out to the insurance, but this can only be achieved with team work. All diagnosis codes, symptoms and conditions the patient is presenting needs to be on the patient’s chart and also on the superbill for the biller to be able to put all this information in the system. Sometimes doctors either rush or have other staff assigned like nurses or physician assistants to complete visits. If a patient’s chart is not well redacted and we have missing information, the result will be a denial of the claim. This will require for the biller to call the insurance and start an appeal of the claim which will require for additional medicals to be sent to the insurance in order for the claim to be paid. This is why is so important for a provider to be very accurate and to send all the pertaining information in the system so that the biller can perform its job. It is also important to notice the recent change in ICD codes and the transition it took. If you send ICD 9 codes some insurances will deny claims because it was effective as of October 1, 2015 (Centafont, 2015) the replacement of ICD 9 to ICD
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