The medical billing and coding systems used in the United States and in most countries around the world have been carefully designed to provide a way to reduce a visit with the doctor, a diagnosis, treatment or procedure to a set of universally recognized codes, or medical billing systems.
To put it in an easy to understand format, the insurance companies pay specific amounts for specific types of treatments, diagnosis, tests and information about the condition and the procedures the doctors use. Having a way to identify each element as a specific service or billable item is at the heart of the development of medical billing systems.
The Need for Standards
There are three different medical billing systems, sometimes called medical billing coding systems that are used by insurance companies and doctors. These include the Current Procedural Terminology (CPT), Healthcare Common Procedure Coding Systems Level l and ll (HCPCS) and the International Classification of Diseases or ICD.
Different types of healthcare facilities will need the use of different medical billing systems. For examples, the CPT is widely used in hospitals, clinics and doctors’ offices, so it is used for billing in both private practice and in large systems in hospitals. On the other hand, the HCPCS is used for Medicare to record the use of equipment and supplies.
Finally, CPT and ICD are used in conjunction to ensure that the treatment and services that are provided to an individual are necessary based on the specific health issues that bring the patient into the healthcare system.
Why Billing Matters
Insurance companies are set up to pay invoices based on the accuracy and the correctness of the medical coding, and subsequent billing, using the respective medical billing systems that are appropriate.
Using an incorrect code or billing for services that are not allowed under the insurance policy based on the condition or presenting issues will result in the claim being denied.
Of course, as new conditions become defined and recognized, the medical billing systems change and expand. This means new additions or revisions. Using old codes or failing to use the new codes for new distinct diseases, treatments, testing protocols or procedures can also result in denial of the claim, which is an issue both for the physician and facility as well as for the patient.
At Omneity Billing, our staff is fully trained, experienced and up to date on all revisions and standards of the three medical billing systems in use today. To learn more see us online.
