Coder Interview

Topics: Health insurance, Health care, Health maintenance organization Pages: 4 (1008 words) Published: October 17, 2013

Kristin Barry
September 13, 2013
HCA 245
Moiz Lalani

Interview with a Medical Coder
Medicine is an art, it is science and business. There are scientific and artistic aspects those doctors learn in the profession of medicine. Doctors have to be paid which requires a different skill that is complex and comes with administrative professional. Hint a Medical Biller and Coding. Medical Billers and Coders work with clinics, doctors, hospitals, patients, and other medical facilities. Submitting claims to insurance companies help ensure that supporting staff and doctors are properly reimbursed for services rendered. When one is a Medical Biller there are abbreviations and acronyms that help save time when filing a claim. Many offices have their own most frequently used acronyms and abbreviations that they use to do their coding and billing. There are many acronyms and abbreviations used in all medical practices. Here are some examples:

EDI (Electronic Data Interchange): Electronic claims that are sent to a central clearinghouse for distribution for individual carriers.

EOB (Explanation of Benefits): This refers to a document that is issued by an insurance company that responds to a claim statement which outlines what services are covered and what services are not, and what level of reimbursement are available.

HIPAA (Health Insurance Portability and Accountability Act): The privacy rule, which outlines certain entities in a person health plan, clearinghouses can disclose or use person health information, and who may be allowed to access a patients personal medical records.

HMO (Health Maintenance Organization): Is a health management plan that requires patients to have a PCP (primary care physician). A PCP is where patients seek out most of their initial treatment at. If the PCP feels like it is necessary to seek treatment from specialist they will send a patient to within that network. CMS (Centers for Medicaid & Medicare Services):...

References: (n.d.) AMA American Medical Association. “The Difference between ICD-9 and ICD-10”. Retrieved July
13, 2013 from
http://www.ama-assn.org/ama1/pub/upload/mm/399/icd10-icd9-differences-fact-sheet.pdf
Marcinko, D. (2011). Recognizing the Differences between Healthcare and Other Industries. Retrieved
July 20, 2013 from
http://medicalexecutivepost.com/2011/01/19/recognizing-the-differences-between-healthcare-and-other-industries/
Smith, Donna. (2013). “Reimbursement Impact of ICD-10: Should You Be Concerned?”. Retrieved from
August 15, 2013 From
http://healthcare-executive-insight.advanceweb.com/Features/Articles/Reimbursement-Impact-of-ICD-10-Should-You-Be-Concerned.aspx
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