The Problem with Communication in Medical Billing

The Problem with Communication in Medical Billing
Tawanua Harding
Colorado Technical University Online


The problem with communication in medical billing
A medical billing specialist has many tasks that go along with their job.   Through the course of their shift they will answer the phone, submit claims, and send out referrals.   Perhaps the tasks they spend the most time on are doing follow up claims.   This is because an improper code was used the first time, or proper documentation was not used to back up the codes that the patient is being billed for.   The most common reason for these rejected claims is bad communication.   There needs to be a better way for physician, and coder to communicate about services that patients receive, and make sure they are using the right billing codes for the right services.
Improper codes are sent for a few different reasons; either a mistake made by the attending physician, a mistake by the coder, poor documentation, or the facility is purposely trying to defraud the insurance company, and patients.   When a physician runs tests on a patient, and fails to document what he did, then the coder of course does not bill for tests that are not noted in the patients chart.   As they say in the medical field if it is not documented, then it did not happen.  
When a medical coder fails to use the correct ICD-9 codes, or fails to provide adequate documentation, then the claim is rejected, and then staff has to spend extra time on follow up claims.   According to one report 53% of billing specialists said they had to spend about 23.10% of their time following up on rejected claims, and according to the national average 69.20% of billing specialists have to follow up on claims (For America‚Äôs Health Care Financial Managers, 09/01/1999 to present).  

Another unfortunate possibility is that it is all too easy for physicians, and billing specialists to defraud the public purposely.   The general public was shocked to find out that...