Coding ? Importance in Reimbursement

Posted by Niurka Moreno on May 29th, 2015

Medical coding has always been one of the vital processes in the US healthcare domain and it demands a good understanding and conversion of the medical record with precision into codes for accurate results. The reimbursement values of a Healthcare Facility or Provider depend on how well its medical coding specialists perform the medical coding process. Since, medical billing, coding and collections go hand in hand with the reimbursement patterns, it is essential that Healthcare Providers and Facilities show great care in avoiding errors.Let us discuss the importance of coding and how it impacts the reimbursement:

Medical Coding:Considered as one of the important steps in the medical billing and collections process, medical codingis done by assigning appropriate codes for the medical procedures and diagnoses performed on patients. The accuracy of the claims is directly proportional to the precision of the codes assigned. It is the sole duty of the medical coding specialists to make sure that no errors occur during the coding process, as both ‘up-coding’ and ‘down-coding’ lead to serious repercussions for the Facility and the Provider.

ICD-10 Medical Coding Implementation: It is expected that the ICD-10 medical coding implementation will take effect on Oct 1, 2015.Medical coding specialists will have the additional responsibility of learning the new coding techniques and implementing the same to avoid healthcare denial management. Proper training and hands-on experience must be provided to every single medical coding specialist by the Provider to enhance the accuracy of the coded data. Certainly, it will demand a huge investment both in terms of money and time. Therefore, Providers can consider medical billing outsourcing as a solution.

Medical Coding Uses: Apart from the financial aspect, which is the reimbursement, medical coding has several other uses. Tracking public health, taking clinical and financial decisions, doing research for future developments, and benchmarking makes medical coding an indispensable part of the medical billing and collections process.Hence, medical coding must be handled with care for accurate results. It can eventually avoid unnecessary healthcare denial management.

Impact on Reimbursement: Inaccurate medical coding results in claim denials which will cause AR pile-up. Providers and healthcare facilities can get their reimbursements only if their claims pass through. Even though, Providers can appeal, the reimbursement patterns may not be the same like the first-pass. Therefore, medical coding specialists must follow the saying ‘Prevention is better than cure’and aim at submitting error-free claims to the Payer.

Solution: As we have arrived at a conclusion that wrong medical coding directly affects the reimbursement patterns of a Provider, it would be judicious to outsource medical billing and collections to an experienced medical billing company. In addition to healthcare denial management, a reputed medical billing company can effectively code claims as per the ICD-10 medical coding conventions when it takes effect in the near future.

About MGSI:

If you are planning to outsource to a highly-experienced and reputed medical billing and collectionscompany, then consider MGSI. Based in Florida,this nationalmedical billing outsourcing company has 21 years of experience in providing end-to-end medical coding solutions to its clients.To learn more details, log on to

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Niurka Moreno

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Niurka Moreno
Joined: May 29th, 2015
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