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A medical coder is someone who translates the patient's information from clinical consultations into number codes that enable processing of the related documents. Coding professional should be equipped with skills in computer literacy which involve various bill preparation and coding computer software, knowledge of basic medical procedures and diseases in order to carry out their duties effectively (Aalseth, 2005).
The medical coding procedure involves the coder either to obtain information from the patient concerning the illness and the kind of treatment given, this is in case the coder have the basic medical and diseases knowledge otherwise he or she gets the information from the medical professionals in the office. Additionally the coder may be needed to also consult and obtain extra information about the clients' insurance medical claims.
Aalseth (2005) asserts that the coder gets the information either through interviews of the patients, or the information may be recorded foe them by doctors. At this point, the medical coders review and interpret the verbal description of diseases and their treatment into a standardized numerical code. Every treatment symptoms, operations, diagnoses, illness and patient encounter has a special code that is programmed in the computer system, and these codes derived from the patients information that are entered into the patient's claim form that is used to enable streamline and facilitate of the processes that involve receiving of reimbursements from insurance, government-based health financing systems and other Medicare systems. The information coded can also be useful to medical practitioners in diagnosis of various medical conditions.
Billing is the last health facility administrative process. Successful billing depends on the success of the coding. The medical biller uses the coded information by the medical coder of the services rendered to the patient, and process them into a statement or rather a bill of treatment services, patient's medical history and other information concerning the existing medical condition. The bill is then presented to the insurance company, an individual or a government agent that is responsible for settling the full and exact costs of the medical services offered to the client (Aalseth, 2005).
Health care billing and pricing differs from other industries in a varied ways, and this is due to various reasons. It is this unique characteristic s of the health care sector that makes it different from other markets of the economy that brings about these differences in charges and prices for the services and medical products. First, if one doesn't get the best health services, she probably dies; this makes it hard for individuals to resist paying high cost for the services acquired (Personalized Medicine Coalition, 2010). Similarly the insurance companies are compelled to comply with their obligation. Besides the above reason, most health care charges are waived by third party and making the people not to feel the cost. Additionally the health care market is not consumer oriented and as a result people are not let to spend hence not developing the prudence of seeking quality care for low costs as is in other market industries. Lastly, the tight government regulations act as a barrier to the health providers hence making the demand to supersede the available quality services.
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Insurance companies, the state and the private payers effect their reimbursement through various ways. Both have put in place payment and coverage policies that encourage in time embracing of advanced personalized Medicine technologies of disease identification and management (John,, 2010). The policies include third party repayment and coverage which are important in ensuring efficiency in access to PM services and products. Reimbursement is also effected by initiating new policies and laws geared towards the expansion of payer reimbursement and catchment of PM services and products with an eventual goal of disease control and prevention. Lastly they impact the repayments by ensuring transparency and also predict payment decisions by use of modern evaluation techniques (PMC, 2010).
In conclusion, medical coders are the experts that are involved in translating the verbal and other raw data about the patient's illness, symptoms, medical background etc. into special codes that represent each of the above information. The coded information is important for insurance companies and government agencies to pay for the services in form of bills. The coded information also is used by practitioners for diagnostic purposes (John, 2010). Coding eliminate fraud in the process of repayment by the insurance companies and other relevant agencies. Lastly, both individually owned and public insurers' agencies have the measure in place to ensure effective repayment of their clients' claims. This include modern technologies in disease identification and management, initiating new policies and laws geared towards the expansion of payer reimbursement and catchment of PM services and products with a objective of disease control and prevention among many others.
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