Coder Interview
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 understanding of their impact on reimbursement.
MEDICAL CODING Medical Coding is the process of using standard codes in identifying medical services and procedure. This is used for billing and reimbursement from payers for services rendered. Medical code is foundational and standardized with industry-wide language. The use of the Healthcare Common Procedure Coding System (HCPCS) is mandated by the Health Insurance Portability and Accountability Act of 1996 (HIPAA), (Medial Billing and Coding).
THE INTERVIEW
I interviewed an outpatient coder of Pennsylvania Hospital. Her job includes coding for hospital out-patients and Physicians’ in-patients and out-patients. She explained medical coding is quite complex and a coder needs proper schooling and training. She is a graduate of Health Information Management, a bachelor degree holder, (Health Information Technology is an Associate’s degree) which provided the foundation of knowledge for her job. Her specific expertise was gained through actual practice. The accuracy of her work is critical because a slight lacking in record or miscoding could result in a bill being denied and unpaid by the insurance company. A double coding on the other hand is considered a
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 understanding of their impact on reimbursement.
MEDICAL CODING Medical Coding is the process of using standard codes in identifying medical services and procedure. This is used for billing and reimbursement from payers for services rendered. Medical code is foundational and standardized with industry-wide language. The use of the Healthcare Common Procedure Coding System (HCPCS) is mandated by the Health Insurance Portability and Accountability Act of 1996 (HIPAA), (Medial Billing and Coding).
THE INTERVIEW
I interviewed an outpatient coder of Pennsylvania Hospital. Her job includes coding for hospital out-patients and Physicians’ in-patients and out-patients. She explained medical coding is quite complex and a coder needs proper schooling and training. She is a graduate of Health Information Management, a bachelor degree holder, (Health Information Technology is an Associate’s degree) which provided the foundation of knowledge for her job. Her specific expertise was gained through actual practice. The accuracy of her work is critical because a slight lacking in record or miscoding could result in a bill being denied and unpaid by the insurance company. A double coding on the other hand is considered a