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Medical coding has two categories: hospital coding and physician coding. Hospital coding is taking a hospital visit (this could be an ER visit, extended stay, observation, surgery, etc) reading over all of the notes, and turning all of that information into numerical procedure and diagnosis codes that will be put into forms and sent to the insurance company. Physician coding is taking the patients' visits (or the physician's part of the surgeries performed), and converting those notes into numerical procedure and diagnosis codes that will be put into a different type of form for the insurance company. Medical billing is the actual submission of these forms, as well as the collection of all of the correct demographic information (patient information, insurance information), and making sure the diagnosis codes match the procedure codes. In addition, if claims are rejected or denied, you need to research them to find out why, make any corrections, and resubmit them if possible. Once the insurance pays the claims, payments need to be posted, and balances moved over to the patient (if there is a balance left). You need to be able to read and understand an explanation of benefits, which is also a remittance advice from the insurance company, so you will know what to post as payment, what to write off, what is the deductible/copay/co-insurance.

The good news for those interested in these kind of jobs is that the training and certification for being a professional or qualified person to do the job is also available online. What you have to do is to check if the provider you have chosen has graduated a lot of successful student, if they are approved and accredited to sell, and if their courses meets your standards.

There are many classes available online now that teach courses on just how to do this. Honestly, you really need both billing and coding do really do the job correctly; you will need medical terminology as well. AAPC has some wonderful courses and resources (www.aapc.com).

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13y ago

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