Medical coder
From Wikipedia, the free encyclopedia
In medical billing, a medical coder is an individual who uses a set of published codes for reporting services provided by a health care provider to an insurer of the recipient of the care. These codes allow insurance companies to map the service provider's services to their equivalent. This process is necessary in order to be able to submit a claim against the recipient's insurance policy for any of the services or items sold to a patient. The codes are also used by local and national governments and private healthcare organizations to conduct research and gather statistcal data about certain conditions, the treatment of those conditions and the outcome of the treatment.
Service providers that do not codify their claims will almost certainly not be reimbursed for their services by the insurance companies, leaving the service providers with either of three options:
- Resubmit the claim with the correct codes.
- Discard the claim, charge the patient for the loss, and leave the patient with the task of recovering the charges.
- Ignore the claim and take the loss.
