Billing and Coding for Health Services Research Paper

Billing and Coding for Health Services - Research Paper Example The interaction is described as the revenue cycle management, which is noted to take a varying amount of time to complete. Medical healthcare providers are observed to contract the healthcare services rendered with a variety of insurance companies. However, the interaction commences after the patient is treated by a physician. There is a trend towards the outsourcing of billing and coding services through the Group purchasing organizations (Reese, 2014). This has been noted to lead to significant reductions in cost. However, there is a growing need to make the billing process clearer to the patients. The codes that are defined in the diagnosis procedures are employed by the insurance companies in the examination of the medical necessity and the coverage. After the determination of the medical procedures and diagnosis, the medical biller is demanded to communicate the claim to the insurance company. Usually, medical healthcare providers utilize electronic transmission, such as electronic data interchange, to communicate the claim to the payer directly. It is integral to note that the insurance company defines the payer; thus, the insurance companies use medical claim adjusters or medical claims examiners to process the claims that are submitted. In the case of great dollar amount claims, the insurance companies examine the claim and value the validity for the eligibility of the payment via rubrics defining patient eligibility, the healthcare service provider’s credentials and the medical necessity of the claim. The approved applications are refunded for an agreed percentage that is negotiated between the insurance companies and the healthcare service providers. However, the failed claims must be communicated to the provider using an Electronic Remittance Advice (ERA). There is a difference between the rejected and denied claims; however, there is a common mistake of