What is medical billing and coding is a question that arises foremost in the minds of those who are keen to take up a career in this industry. Medical billing is typically the process through which doctors and hospitals get their payments from any health insurance company. This process may include resolution of any disputes that may arise regarding claims which have either been rejected or delayed. Medical billing and coding is actually a series of complicated procedures which requires skilled professionals and a substantial amount of time in order to be executed properly.The bigger hospitals typically have a separate department to deal with medical billing and coding. Through this department, claims are submitted to various insurance companies for a response. In cases, where no action is taken by these companies, the individuals in question may approach the insurance giver. It is therefore crucial to any healthcare company. The nature of the whole process will depend on the kind of insurance because companies have varying policies based on diverse requirements. Medical coding is indeed a challenging task and often companies may have to outsource this job because they do not have the necessary staff for it.Medical Billing and Coding As a Career Option:Those who are skilled in performing this work can make a living out of it. A visit to a doctor’s chamber is followed by various tests performed as part of treatment and these medical records are essential for it to be accurate. There are electronic medical billing devices which can extract information from these medical records and assign codes automatically. This bill is then checked manually by a staff member.Once codes are assigned, the bill is submitted to the insurance giver. This information is reviewed to see if the treatment offered is relevant to the diagnosis and whether the tests done are medically justifiable. Once the bill is approved, the payments are made to the doctor electronically. When rejected, a notice of denial is sent to him. Whatever the result, the patient is informed through an EOB (Explanation of Benefits) letter. Medical coding is complicated and errors in data entry are quite common. This means that claims may have to be submitted many times before they are approved.What Does A Medical Billing And Coding Specialist Do?* The medical and billing coder is responsible for recording data accurately and processing a patient’s medical data like his treatment records, bills, insurance details and payments received.* He transfers requests for payment to the insurance companies, organizes patient records, statements and bills and ensures that these are free from errors.* Communicates with the insurance companies for policy verifications and payment processing.* Where extra payments not covered by insurance are deemed necessary, they formulate the payment plans.Medical billing and coding specialist are employed in hospitals, doctor’s chambers, healthcare institutions and even in rehabilitation clinics. To become one, a person must have a high school diploma and in some cases, a bachelor’s in business administration or associate degree qualification. They learn what is medical billing and coding through on-the-job training. To improve their qualifications, many choose to obtain certifications from reputed national organizations. Job prospects are abundant for these professionals and with computer technology being used more and more in healthcare facilities, the demand for knowledgeable, qualified, tech-savvy medical billing specialists is expected to grow.
When the 2010 Patient Protection and Affordable Care Act became law, it changed the way health care was provided for millions of Americans. The health care reform law made several changes in the health insurance industry, but not all of them were intended.One of the unintended changes in the insurance market involved child-only health care policies. In Georgia and other states, as the Affordable Care Act took hold, insurance companies stopped offering this type of healthcare plan.Child-only Georgia health insurance plans are usually bought by parents who have an employer-provided health plan that does not include dependent coverage, or has dependent coverage they just can’t afford. Sometimes these plans are bought by parents who can’t get health coverage for themselves due to health reasons and still want to provide coverage for their children. And sometimes, these are bought by parents whose income does not qualify for their kids to get coverage under Medicaid or PeachCare.How Did The Affordable Care Act Affect Child-Only Policies?One of the mandates of the act is that no children with pre-existing conditions can be denied health coverage. In response to this mandate, insurance companies in various states, including Georgia, stopped offering new individual plans that only cover children.According to the insurance industry, under this new requirement, parents could postpone getting health care coverage for their children until the kids were sick. The industry said that this would cause a rise in unprofitable health care plans and skyrocketing expenses for the insurance companies to budget.Will Child-Only Georgia Health Insurance Plans Return?An increasing number of states have made a move to address the loss of availability of child-only health care policies, either through legislation or regulation.In Georgia, House Bill 1166 was presented to address this problem. HB 1166 plans to restore these child-only health policies that can be offered by the private Georgia health insurance market.Legislation recently passed the House Insurance Committee that would require Georgia health insurance companies that sell individual health coverage to also offer child-only health care plans during an open enrollment period. The bill would permit insurance companies to impose a surcharge of 50 percent of the premium if a child has been without health coverage for more than 63 days prior to the application for coverage. By doing so, this will motivate parents to keep their children insured and not wait for their child to get sick before getting a Georgia health insurance plan.According to Graham Thompson, executive director of the Georgia Association of Health Plans, the healthcare insurance industry has signed off on the legislation.It was Cindy Zeldin, executive director of Georgians for a Healthy Future, who pushed for the bill. She said that fixing up this unintended consequence of reform is relatively easy. This will help kids get the Georgia health insurance coverage they need since having health coverage is very important. Hospital admission records from 37 different states all showed the dire consequences of not covering children with health insurance. Regardless of the hospital where they were admitted, children without health insurance died 60 percent more often than kids who were covered. The reason for admitting them to the hospital did not alter the outcome, either. Children without health care, like adults, died more often even in the hospital. Zeldin also added, “It’s unfair that some parents are willing to pay for healthcare coverage for their kids, and it’s not available.”The bill just covers one year (2013) since the problem will be taken care of by 2014 when federal health care reform will be totally implemented. By then, the new state-based Georgia health insurance market should be up and running with new Georgia health coverage options.