We know medical billing and coding can be confusing. There are so many moving parts, especially in billing and insurance. It can sometimes feel like it’s an entirely different language.

In truth, that’s not too far off from what medical billing and coding are. It’s how insurance and billing companies interpret patient visits and treatment to ensure medical service providers are paid accurately. So, as you can see, knowing how to interpret and use these codes is a much-needed skill. Yet, where do you find the Duolingo support for it? With Aspen Ridge, of course!

But first, let’s break down medical billing and coding in a way that’s easy for everyone to understand.

What is Medical Billing and Coding?

Medical billing and coding is a two-part process.

Medical Coding

In the medical industry, specific codes are assigned to every patient’s diagnosis, treatment, and procedure. These codes come from standardized systems, such as the International Classification of Diseases (ICD-10) for diagnoses and the Current Procedural Terminology (CPT) for procedures.   

These codes ensure everyone involved – from doctors and nurses to insurance providers – is on the same page. When a patient visits a health care provider, the provider documents the patient’s diagnosis and treatment in their medical record. A medical coder then reviews this information and assigns the appropriate codes.

Medical Billing

The codes are used to create the claims (bills) sent to insurance companies.

These claims tell the insurance company precisely what services the patient received so they can pay the health care provider.

How Does It Work?

1. Patient Visit. The patient receives medical care.
2. Documentation. The provider creates a detailed record of the patient’s visit, including diagnosis, treatments, and any procedures performed.
3. Coding. A medical coder reviews the documentation and assigns the correct codes for each service.
4. Billing. A medical biller uses the codes to create a claim and submits it to the insurance company.
5. Insurance Processing. The insurance company reviews the claim and decides how much to pay the provider.
6. Payment. The provider receives payment from the insurance company (and sometimes the patient, depending on their coverage).

Why is It Important?

• Proper Payment: It ensures that healthcare providers receive the correct service reimbursement. This helps them keep their doors open and continue providing care.
• Patient Care: It helps create a clear and organized record of a patient’s medical history. It also helps prevent medical errors.
• Financial Stability. It helps healthcare facilities manage their finances effectively. This enables them to invest in new equipment, hire more staff, and expand their services.
• Reduced Fraud. Proper coding helps prevent fraud and abuse in the health care system.
• Health Care Improvement. Medical billing and coding data help track important healthcare trends and statistics. This information can be used to improve healthcare services and public health initiatives.

Common Medical Billing and Coding Challenges

Even the most experienced healthcare professionals can find medical billing and coding challenging.

So, what are the main complaints?

• Coding Errors. Even small coding errors can lead to claim denials and delayed payments.
• Keeping Up with Changes. Medical codes are constantly updated, making it difficult to stay current.
• Complex Regulations. The healthcare industry is heavily regulated, with complex rules and guidelines for billing and coding.
• Claim Denials. Insurance companies often deny claims for various reasons, requiring time-consuming appeals and follow-ups.

How Aspen Ridge Can Help

We specialize in medical billing and coding for behavioral, mental health, and addiction recovery facilities. We handle the entire process, from verifying patient benefits to submitting claims and following up on denials.

Here’s how we can make your life easier:

• Reduce Your Administrative Burden. We free up your staff so they can focus on patient care.
• Improve Your Revenue Cycle. We help you get paid faster and more accurately.
• Minimize Claim Denials. Our expertise helps prevent errors and ensures your claims are processed smoothly.
• Stay Compliant. We keep up with the latest regulations, so you don’t have to.

Aspen Ridge is passionate about helping healthcare facilities succeed. By taking care of your billing and coding needs, we help you give your patients the best possible care.

Why wait?

Let’s talk about your medical billing and coding needs and how Aspen Ridge can help. Contact us today!