Medical Insurance Coding

Medical insurance coding, the assignment of a numeric or alphanumeric code to a diagnosis, procedure or treatment is used by the staff in the physician's office to submit claims for payment to insurance companies. It is also used by insurance companies to monitor the delivery of health care services. In this manner, medical coding is extensively used in insurance.

Medical Coding in the Insurance Industry

Commonly known as “pre-authorization”, insurance companies and health maintaince organizations use medical insurance coding to determine what services are covered under a patient's health plan as well as to determine what level of care will be authorized. Medical coding in the insurance industry is vital to the delivery of health care services because without pre-authorization a patient can be denied services or later finds himself with a bill for services that are not part of their health care coverage.

Here's how it works: When a patient needs a diagnostic test or a procedure, the physician's nursing staff or office manager will contact the patient's insurance company. When the insurance company is contacted, the physician's staff will provide information about the patient's diagnosis and treatment plan including the medical coding appropriate to each. It is up to the insurance company to authorize services, meaning they will later be responsible for payment for services received. A physician may suggest one type of treatment but at the same time the medical insurance coding worker may suggest another course of treatment which is less expensive and which still meets the goal of treating of the patient.

Medical insurance coding workers have a challenging role as they are working on the behalf of the insurance company and patients to keep costs down .At the same time, they have to respect the physician's judgment on what is in the best interest of the patient's care.

For these reasons, medical coding in an insurance related job requires exceptionally strong skills in coding, billing, customer relations and negotiation.

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