Role of Medical Billers and Coders in RCM

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Role of Medical Billers and Coders in RCM
Medical billing and coding translate a patient
encounter into the form healthcare facilities use
for claims submission and reimbursement. Medical
billing and coding are separate processes, but
both are necessary for providers to receive
reimbursement for healthcare services. Medical
Billers and Coders play a crucial role in revenue
cycle management as their work starts from
patient registration and ends with providers
receiving accurate reimbursement for delivered
services. Medical Billers and Coders are
well-versed with medical billing and coding
guidelines and payer reimbursement policies.
These guidelines and policies keep changing
frequently, recently due to pandemics. In this
article, we will discuss the role of medical
billers and coders in RCM and the cost of
incorrect medical billing and coding. Role of
Medical Billers Medical billing involves
preparing billing claims and submitting them to
insurance carriers. Medical billers ensure that
the medical practice is reimbursed the correct
amount for the services that they provide
patients. Once a patient visit is completed, the
provider assigns diagnosis and procedure codes to
the interaction. These codes help insurance
companies to assess the claim and any associated
coverage.
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Role of Medical Billers and Coders in RCM
Without accurate reimbursement, it is difficult
for practices to provide stellar healthcare to
patients. Billers are involved in various RCM
processes like patient registration eligibility
and benefits verification prior authorizations
charge entry payment posting denial management
correcting rejections and account receivable
management.  The Cost of Incorrect Medical
Billing As discussed earlier medical billing
helps practices to receive accurate
reimbursements for delivered care. Medical
billers will submit claims to various insurance
carriers with important information like patient
info insurance details diagnosis codes
procedure codes rendering provider details
billing practice details and others. Any
incorrect information in a claim will result in
denied payment from insurance carriers. Examples
of incorrect medical billing are duplicate
billing, wrong procedure codes, and poor
documentation. Medical fraud occurs when a false
claim misrepresenting the facts is intentionally
submitted to insurance carriers to receive higher
payment.  
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Role of Medical Billers and Coders in RCM
Role of Medical Coders Medical coding is the
process of translating important medical
information into simple codes for the purpose of
documenting medical records and for medical
billing. This standard system of medical coding
allows a more seamless transfer of medical
records and more efficient analysis to track the
health records of patients. The revenue cycle
starts with medical coding. Coders take medical
reports from providers, including a patients
condition, diagnosis, and prescription which make
up a crucial part of the medical claim. The most
important part of a medical coders job is to
ensure that all of the coding and billing
information is accurate and correct. 
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Role of Medical Billers and Coders in RCM
The Cost of Incorrect Medical Codes In the
healthcare sector, medical coding errors result
in over 50 percent of claim denials, loss of
revenues, HIPAA violations, and the prospect of
legal lawsuits and hefty federal fines. Once a
claim is rejected or denied, the regular revenue
stream is affected, and healthcare providers are
not billed on time. Not only the regular payment
is impacted, but it takes time, and effort to
identify and resubmit the claim and the insurance
provider may then only agree to make a partial
payment. Medical coding error not only results in
loss of revenue but also compromises patient care
and a patient has the right to file for
malpractice that can result in added payment of
expensive fines and legal fees.  Medical Billers
and Coders ensure timely collection of insurance
and patient reimbursements. Its really important
to have experienced medical billers and coders in
your team who have your medical specialty
experience. Solo or small practice owners often
handle medical billing and coding operations all
by themselves which could result in inaccurate
medical billing. A lot of their time is utilized
in administrative work which could be used for
better patient care. In such cases, outsourcing
medical billing operations could help. 
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Role of Medical Billers and Coders in RCM
About Medical Billers and Coders (MBC) Medical
Billers and Coders (MBC) is a leading medical
billing company providing complete revenue cycle
management services. We will handle all billing
and coding operations on your behalf. Our
specialty-wise billers and coders ensure timely
collection of insurance reimbursements for
delivered care. With our RCM reports, you will
get a complete understanding of the number of
claims submitted the number of claims paid and
the outstanding patient and insurance amount. As
we handle all functions of medical billing and
coding, you can focus on the core function of
your practice i.e., patient care. Streamline
your revenue cycle and prioritize patient care
with MBCs expert medical billing and coding
services. Contact us at info_at_medicalbillersandcod
ers.com or call 888-357-3226 to ensure accurate
reimbursement and seamless operations for your
healthcare practice. FAQs 1. What is an RCM
coder? An RCM coder translates medical
information into billing codes for revenue cycle
management.
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Role of Medical Billers and Coders in RCM
2. Why is medical coding important in the
RCM? Medical coding ensures accurate billing and
reimbursement for healthcare services.   3. What
is the role of medical billers and
coders? Medical billers and coders handle billing
claims and coding processes for healthcare
providers.   4. What is the difference between
RCM and billing? RCM encompasses the entire
revenue cycle, while billing is just one part of
it.   5. What does RCM stand for in medical
billing? RCM stands for Revenue Cycle Management,
focusing on financial operations in healthcare.