Coding and Billing

Medical billers, private insurance and government insurance programs use standardized medical coding (such as ICD-10, CPT and HCPCS) to describe conditions, interventions and supplies/equipment when submitting claims.
This consistency not only helps streamline the claims and billing process for efficiency, but aids in quality measurement, analysis of disease patterns and the ability to track and respond to public health outbreaks:

• When everyone uses the same language (terminology) and shorthand (codes), all parties from providers to billers to payers understand what everyone means. Charting records and submitting, reviewing and processing claims becomes faster and more accurate because there is little left to interpretation.
• The Health Insurance Portability and Accountability Act, which sets healthcare confidentiality standards in the U.S., requires the use of medical codes to help limit the transference and exposure of personal health information as claims move from providers and billers to processors and payers.
• As the medical systems increases its emphasis on tracking quality management, it’s much easier (or only possible) to benchmark and comparing outcomes data to that of industry standards and best practices when everyone is using universal codes. This exchange of information ultimately leads to better care.
• Public health trends and statistics—and well as real-time outbreak monitoring—are possible through analyzing coded data.

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