Information in healthcare is everything, it’s so essential to medicine that it requires a unique training program to manage. The study of health information technology is taking how we approach data management science to a whole new level. If you’re ready for a future-forward, data-driven career in an up-and-coming field, working as a medical billing and coding specialist might be just what the doctor ordered.
What is Health Information Technology?
Health information technology is the study of how medical data is organized, shared and stored. It governs how records are used by patients, doctors, insurers and quality monitors.
Why is Health Information Technology Important?
In the 21rst century, information gleaned from insurance claims guides both reimbursement and public health policy. Data is used by insurers to justify payment and allows the government to track healthcare trends that impact policy and budgeting decisions. Billing and coding are the engines that make healthcare work.
What Does a Medical Billing and Coding Specialist Do?
Health information technology supports medical records to obtain reimbursement for medical practices. The majority of healthcare services in the United States are paid for by insurance companies. Each has a vested interest in ensuring they pay only for services covered by the patients’ policies.
A medical billing and coding specialist’s primary responsibility is to complete insurance claims with the detail insurers require, so hospitals and doctor’s offices get paid on time and patients are spared unexpected bills. Responsibilities involve using medical coding systems, coding accuracy, tracking claims and payments, troubleshooting delayed or denied claims, and improving claim processing efficiency.
Medical Coding Systems
Used to describe symptoms, diagnoses and the resources used to treat patients. Imagine having to send insurance companies entire medical records to justify a claim, the sheer volume of information would be overwhelming. Instead, alphanumeric coding systems are used as a type of shorthand, limiting the size of files.
Medical coding also serves as a universal language, so non-clinical staff can understand it at a glance, while doctors can use it to review data in a hurry, boosting the speed and efficiency of care.
Coding Accuracy
Medical billing and coding specialists work with clinical and administrative staff to ensure coding accuracy. They work closely with clinical staff to make sure claims are accurate. A small portion of claims are rejected for coding errors, leading to reimbursement delays and possibly, medical errors.
For example, if an initial claim is coded for repair of a broken leg, subsequent submissions coded for pregnancy make no sense. Claims software catches obvious errors, so they can be corrected before submission, but subtle mistakes such as coding a diagnosis of osteoarthritis instead of rheumatoid arthritis will result in claims denials for medications that treat one but not the other. Coding accuracy is a must.
Tracking Claims and Payments
An average medical practice submits hundreds of claims per day, hospitals and medical billing services process thousands. Medical billing and coding specialist use health information technology to manage each claim from start to finish, including posting the payment that wraps up the claim. Depending on experience, medical billing and coding specialists will review between over 30 records daily. It’s fast-paced but satisfying work.
Troubleshooting Delayed or Denied Claims
It’s not uncommon for insurers to request more information about a claim. It’s a medical billing and coding specialist’s role to respond to inquiries and forward data. The process may require clarifying details with clinical staff or reaching out to the patient directly for information. The goal of health information technology is to respond in a timely fashion, so payment and ongoing care are not delayed.
Improve Claim Processing Efficiency
Being efficient with electronic health records pays in more way than one. Recognizing that switching from paper records to an exclusively digital system required costly health information technology upgrades, government insurers, Medicare and Medicaid, offer incentives for their “meaningful use.”
Meaningful use is defined as a way that helps the nation improve the safety, quality and efficiency of healthcare. Medical billing and coding specialists conduct occasional audits of billing and coding practices as part of the EHR Incentive Program.
What are EHRs?
Sorting through paper charts for information is cumbersome, time-consuming and costly. In an effort to lower costs, the federal government required a transition to electronic health records (EHR) in 2014, under the Patient Protection and Affordable Care Act. Goals included enhancing the quality, safety, and efficiency of healthcare by providing a platform for improved care coordination. The good news is, it’s working. EHRs include all pertinent patient signalments and data, including:
- Demographics
- Medical history
- Medication and allergy lists
- Vaccination status
- Diagnostic test results
- Recent exam notes
- Vital statistics
- Billing information
Physicians have immediate access to patient records at any given location, cutting down the time it takes to find the information necessary to make sound clinical decisions. EHRs also facilitate patient privacy and convenience, doctors can review test results, send orders to the hospital or write prescriptions with a few mouse clicks. Software checks for drug interaction or duplicate orders automatically. The result is better, safer care at a lower cost.
Health Information Technology Coding Systems
Medical coding systems are sets of numeric or alphanumeric codes that correspond to symptoms, diseases, procedures and medical supplies and associated professional services. Most are used globally, but select codes are specifically for Medicare and Medicaid patients. The most common health information coding systems are ICD-10, CPT & HCPCS.
ICD-10 Coding System
ICD-10, or the International Statistical Classification of Diseases and Related Health Problems was first developed in 17th century Europe. Now in its tenth edition, it’s the oldest and most often used coding system in the world.
Codes are alphanumeric and have been used by global health authorities since the 1970s to categorize every symptom, injury, medical condition and cause of death known to medicine. They’re used by public health departments to track disease rates and insurers to justify paying for treatments.
For example, the code for influenza with associated bacterial pneumonia is J09.X1. It tells insurers why they’re being billed for a chest x-ray and antibiotics. If dozens of similar claims are recorded simultaneously in the same geographical area, government officials know they may have an epidemic on their hands, and they can plan accordingly.
The World Health Organization is responsible for updating ICD codes. Lists of changes are published annually and with overhauls averaging every ten years. Health information technology never stops evolving.
CPT Coding System
CPT, or Common Procedural Codes, are five-digit numbers given to all medical, surgical or diagnostic procedures. Developed in 1966 by the American Medical Association and updated yearly, they’re used for reimbursement and to collect data on the treatment outcomes monitors use to set benchmarks and assess quality of care. CPT codes are used in conjunction with ICD-10 codes on claims forms to give insurers a better picture of a patient’s health.
For example, an emergency room visit for dysuria, or painful urination, is first given ICD-10 code R30.0. The subsequent bladder scan receives CPT code 51798. Combined, they make sense.
HCPCS Coding System
HCPCS, or the Healthcare Common Procedure Coding System, is a dual-level alphanumeric system exclusively developed for Medicare. Level I is the CPT index, Level II codes medical products, ancillary professional services such as anesthesia and radiology and non-professional services warranted as part of a patient’s treatment plan.
There are currently 17 Level II categories and more than 4000 subcategories and counting. Used with ICD-10 and CPT codes, HCPCS code paint Medicare a clear picture of medical necessity.
For example, if the doctor prescribes a urinal for the patient with dysuria who had a bladder scan, the claim form would contain the ICD-10 code R30.0, the CPT code 51798 and the HCPCS code E0325.
And just like that, three simple codes replace pages of data that can be used by insurers, doctors, pharmacies and medical providers to serve the patient efficiently. As long as the data is accurate, the system works.
Final Thoughts
Health information technology is a vital field with many opportunities for detail-oriented, tech-savvy students. With the right education, a new career and a secure future could be just months away.
Want to learn more about health information technology? Ready to attend Medical Insurance Billing & Coding program at Meridian College? Medical Billing and Coding professionals are responsible for keeping the records, charts and bills in a medical office in order. In addition to the classroom experiences, students will also complete an externship for on-the-job training that will bring them further expertise.
Contact Meridian College today to learn more about becoming a medical billing and coding specialist.