Coder Interview - 1247 Words

CODER INTERVIEW Kathryn L. Elican Grand Canyon University: HCA-530 April 3, 2013 CODER INTERVIEW Like a regular business entity, healthcare facilities need continuous inflow of funds to continue existing. However, billing complexity in the health care industry is unlike all other industries. The biggest difference of healthcare from other businesses is the source of payment for services rendered: the majority of which is from a third party with pre-determined rates and strict prerequisites. Foundational to these prerequisites is the accuracy of medical coding. An interview with a coder provided fresh understanding of the coding profession. And a look into the private and government payers and insurers’ roles brings better†¦show more content†¦Data then flows into two functions: (1) the medical documentation, which becomes the basis for clinical decision making and goes into the medical record; and (2) the charge capture or entry, where the manual â€Å"charge slips† or automated direct order entry are priced in accordance with the price l ist referred to as Charge Master, also called Charge Description Master (CDM). Thereafter, data from both Medical Record and Charge master flow right into the billing system. Then, claims preparation follows by filling up of either of the two types of forms: (1) UB-04, which is used by hospitals for inpatient and outpatient service claims, or (2) CMS-1500, which is used by Physicians for professional claims. These forms are then carefully reviewed in the claims editing process to ensure there is enough information to warrant payment by the payer, and logical standards are complete and well documented. (Claims Editing is not conducted by all health care facilities, but is a critical effort to secure accurate and timely payment by payers). Finally, the claims are submitted to the payers. CHARGING AND PRICING PROCESSES: HOW HEALTH CARE DIFFER FROM OTHER INDUSTRIES The biggest difference of the billing process of health care compared to other industries, is the payer. In business, the recipient of the product or service sold is the payer, and the one setting the price is the seller. In health care, the majority of payment is made through a third party, and the ratesShow MoreRelatedCoder Interview1019 Words   |  5 Pagesï » ¿ Kristin Barry September 13, 2013 HCA 245 Moiz Lalani Interview with a Medical Coder Medicine is an art, it is science and business. 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