Topics:
- Introducing medical billing and coding
- How does medical billing work?
- How does medical coding work?
- What differentiates ASC billing?
How about we make what is medical billing and coding in ASC simple for you? Let’s figure out the definitions, differences, similarities, and specificities shortly.
First and foremost, you need to know that ASC billing differs from regular facility or physician billing. Usually, physician billing requires abiding by guidelines for reimbursement. On the contrary, ASC billing and coding doesn’t revolve around one medical specialty.
In an ASC context, you don’t need a coding system to be centered on precise procedures, services, or diagnoses. Why? Because ASC has all specialties in a unified place.
However, as an ASC biller, you don’t need to worry about learning a new set of billing techniques and codes. Normally, Ambulatory surgical center billing allows the usage of the same billing techniques, codes, and guidelines within the medical industry. Yet, what makes ASC coding and billing different? Follow us until the end to find out.
Introducing medical billing and coding
To understand what is medical billing and coding in ASC, you need to grasp medical billing and coding in general. Firstly, medical billing is following up and submitting claims with health insurance companies. The target is to get paid for the services that a healthcare provider offers. The medical bills are the one that links insurance companies and healthcare providers. In fact, they are responsible for ensuring that you, as a healthcare provider, get your reimbursement. The process of medical billing starts when your patient calls a doctor for an appointment.
Secondly, here’s what you need to know about medical coding. For every diagnosis, medical procedure, or injury, an appropriate code. Prices come up based on the nature of the treatment and diagnosis that the medical coding reports.
A good medical coder is familiar with a variety of sets and subsets of codes. These include ICD or the International Classification of Diseases codes, corresponding to the sickness or injury of a patient. Besides the CPT Current Procedure medical terminology codes, relate to services and functions the provider performs. Universally, doctors, insurance companies, hospitals, and other organizations use these codes.
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How does medical billing work?
The answer to what is medical billing and coding in ASC needs some medical billing process knowledge. Truth is, the medical billing process is what happens between the healthcare industry providers and the insurance company. In fact, the latter pays the first. You can refer to the medical billing process as Revenue Cycle Management RCM. RCM includes managing payment, claims, and billing:
1- Assignment of the codes based on the appointment of the patient with the doctor
2- Transmission of the claim to the insurance company
3- Processing of the claim by medical claims adjusters and examiners within the insurance company
4- Approval of claims and reimbursement for a particular percentage of the billed service
5- If the claim gets denied, the provider receives a notice
How does medical coding work?
The second phase of what is medical billing and coding in ASC is the uncovering of medical coding. Previously, we explained that medical coding is the transformation of operations into codes. Additionally, you can take the procedure and diagnoses codes from record documentation. For example, radiologic results, lab results, doctors’ notes, etc. A medical coding professional ensures the application of codes is correct during the billing process. Namely, the assigning of the appropriate codes, the abstracting of the information, and the creation of a paid claim. From the medical code translated from the documentation, a payer tells this:
1- Any uncommon condition or circumstances affecting the service and treatment
2- Services, treatments, and supplies that were given to the patient
3- Medical necessity for services, supplies, or treatments received by the patient
4- The diagnosis of the patient
What is the difference between billing and coding?
Both medical billing and coding involve many aspects. It all starts with the registration of the patient, then with the secure claim reimbursement, and finally the payment to the provider. Coders and billers collaborate. Overall, the collaboration includes the patients, insurance companies, and staff. Often, the two terms are interchanged. How are they different then?
1- Different types of work: this means different skills and capabilities.
2- Personality: usually, extroverts prefer to work in medical billing. But the introverts are better at medical coding. This is due to the fact that billers work with patients while coders remain behind the scene.
3- Bigger healthcare practices split duties while smaller facilities merge the tasks.
4- Medical coding is more like an alliance role while medical billing is more autonomous.
5- billing and coding professionals or the billing and coding specialists can be one person at smaller facilities taking care of billing and coding processes.
What differentiates ASC billing?
Finally, as promised, you will what makes ASC billing and coding different. Basically, ASC billing and coding resembles billing hospital codes through the CMS-1500 claim form, which is different from a form related to the facility. Also, ASCs only offer services to people with a prior diagnosis from a primary care doctor. These are the ones in need of medically necessary procedures for the ASC to receive reimbursement.
This was a general overview of the medical billing and coding in ASC and general context. There are further details you can look up online to learn more about these services, especially when it comes to coding and technicality.
We, at the Ambula Healthcare team, are more than happy to answer any questions you have: (818) 308-4108! And now how to market your surgery center?
