English 0301 Essay Zone: Example Essays

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Essay Form and Organization / Punctuation

Example Essay #2

Billing and Coding of a Medical Claim 

       My name is Brandy and my job is medical billing and coding.  In some ways it is exciting and difficult at the same time.  The process is not hard if you know what you are doing.  What are the steps involved with doing medical billing? By the end, you will completely understand the process of how your doctor’s visit is billed and paid.

            The process starts once you receive the encounter form from the physician.  This occurs once the physician has finished making notes and charges.  First, you must verify that the personal information is correct for the patient.  Once you’ve done that, look over the encounter form and make sure that the diagnosis are legible.  The next step would be to look over the charges.  It is important to make sure that the procedures are marked and that they are age appropriate codes.

            There are different physicians and they sometimes do their own coding, where there are others that rely on the coder.  This means that you will have to look the diagnosis up in the ICD 9 book do obtain the numeric for the diagnosis.  This process is also the same for any procedures that are done; the difference is that you use a CPT book to obtain this information.  Depending on whether or not there was a procedure done in addition to an office visit will determine whether you need a modifier.  A modifier makes the insurance company aware that this procedure was not part of the office visit and should be paid for separately.  Another important factor to look for is with biopsies.  When a patient has a biopsy done, you must wait for the pathology report to come back before it can be billed.  This is done because when it is coded it is very important to know whether the biopsy was malignant or benign to code it properly.

            The billing process starts by pulling up the patient in the system.  Using the patient’s social security number or the patient account number is how this can be done.  After you have obtained the numeric of the diagnosis they must be entered, primary diagnosis first.  Then you must make sure that you link the correct procedure with the correct diagnosis.  For example, you wouldn’t link the diagnosis of pharingitis with a knee x-ray.  Another important factor is to check the insurance information.  Verify the insurance in the system is also what is on the encounter form.  This helps ensure that there is less chance of a denial.       

            A few weeks later, the payment process has begun.  This is started by receiving the check from the insurance company along with an explanation of benefits.  An explanation of benefits gives us the information of how the date of service was paid.  Most companies give us a 90-day filing deadline.  The money is posted by line item.  There is always a provider discount that every doctor’s office is expected to write off.  The only case that the charges are not paid in full after the provider discount is that the charge was not covered under your plan or the balance was applied to the deductible.  If this occurs then the balance is the patient’s responsibility, this is why it is important to know what your health plan covers and your deductibles.  The information that has been provided is the full process of what happens once you leave the doctor’s office.