The function I chose to discuss is...”Clinical Coding of Diagnoses and Procedures”
Clinical coding… is the process of assigning numeric or alphanumeric classifications to a diagnostic or procedural statement. This function is used for billing and payment purposes, as well as for research and quality performance reviews.
Medical billing and coding specialist are the glue that holds together every healthcare facility… healthcare providers can 't stay in business without the help of good billers and coders, because without them the facility doesn’t get paid. Traditionally in the past, billers have either been trained on the job or have been medical coders who do both the coding and billing. However, there is a shortage of billing/coders
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For example, up-coding occurs when a physician examines a patient briefly for a simple matter such as a cold but submits a bill for an hour-long complex visit; or when a pharmacist provides a patient with a low-cost generic but submits a bill for a higher-cost branded drug.
· "Unbundling" refers to the practice of using two or more Current Procedural Terminology (CPT) billing codes instead of one inclusive code. It also refers to the practice of submitting multiple bills in order to obtain a higher reimbursement for tests and services that were performed within a specified time period and which should have been submitted as a single bill.
· "Double billing" occurs when a provider attempts to bill Medicare / Medicaid and either a private insurance company or the patient for the same treatment, or when when two providers attempt to get paid for services rendered to the same patient for the same procedure on the same date. Double billing also occurs when a provider attempt to charge more than once for the same service, for example by billing using an individual code and again as part of a bundled set of