FAQs
What is the primary responsibility of a Medical Coder in the Submission Team?
The primary responsibility is to follow the mandatory SOP, checklist, and relevant payer and coding guidelines to ensure accurate coding and billing processes.
Is there a specific educational requirement for this position?
Yes, a Bachelor's degree along with CPC Coding certification from AAPC is required.
How do Medical Coders ensure the accuracy of patient information?
Medical Coders check the demographic details of patients and ensure the front desk selects the proper regulatory policy (DHPO or RIAYATI).
What documentation practices are required from doctors?
Proper documentation must be entered in the Chart, EMR, and Claim form by the doctors, including supporting details and justification for all investigations done.
What guidelines do Medical Coders follow for CPT codes?
Medical Coders check that all CPT codes entered are correct based on CPT guidelines and also verify excluded ICD and CPT codes according to coding standards.
How is the accuracy of claims verified before submission?
Claims are checked for the correct Receiver and Payer name, correct Patient Copay application, and that all approved services match the rendered services before finalizing the bill.
Are all claims submitted to insurance companies?
Yes, ensuring all claims are submitted to the insurance company is part of the job responsibilities.
What should be done if requested investigations are not invoiced?
Medical Coders must ensure that all requested investigations are done and properly invoiced.
How do Medical Coders verify payer information?
They check the payer’s name, rate plan, and plan name to ensure proper selection during the claims process.