Reimbursement for services provided involves the clinical team as well as business office staff, including billers and coders with specific roles in processing payments. Medical billing clerks interpret medical codes and submit bills to insurance companies, patients, and other agencies for services. A medical coding specialist is part of the medical records billing department of a health care organization such as a hospital or a clinic. The coding specialist classifies diagnoses and procedures to facilitate billing and reimbursement from Medicare or health insurance companies. It is very important that each one does their job correctly. The medical coding specialist will be the focus of this discussion.
You have just been hired as the coding supervisor for Big Wheel General Hospital. You were warned before taking the job that there were some issues with the department but you decided you were up to the challenge. Your first and perhaps most important task is to review the noted problem areas and submit a memorandum to the HIMS Director, Betty Kline, identifying the top two priorities and offering strategies to address these issues.
These are the issues you have identified:
Not coding at the highest level.
Flawed or missing documentation.
Lack of access to the provider.
Failure to use current code sets.
Under- and overcoding.
Unbundling.
Submit a memo to Ms. Kline in which you:
Identify the top two issues you consider the most urgent priorities to be addressed.
Offer strategies to resolve each issue.
Be sure to respond to at least one of your classmates’ posts, comparing your two priorities and strategies to theirs.
Supplemental Resources
What Does a Medical Biller Do?
What Does a Medical Coding Specialist Do?
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