Hi,
I just want to make sure I am doing this assignment correctly.The question is:
How are medical coding, physician, and payer fees related to the compliance process?
I believe that they are related because the medical coding specialist is required to know what the patient's insurance plan will be paying for. Establish an estimate of what the patient will be owing and prepare a compliant claiim.
Appreciate the help. Thank you.
Evidentally you didn't read the responses to your previous post.
http://www.jiskha.com/display.cgi?id=1289781994
Hi,
It looks like you have a good understanding of how medical coding, physician fees, and payer fees are related to the compliance process. I'll explain it in a bit more detail for you.
Medical coding plays a crucial role in the compliance process. It involves assigning standardized codes to medical procedures, diagnoses, and services. These codes are used by healthcare providers, insurance companies, and government agencies for various purposes, including billing, reimbursement, and data analysis.
Physician fees refer to the charges that physicians or healthcare providers set for their services. These fees are often based on the complexity and intensity of the medical procedures performed. It's important for medical coding specialists to accurately code and document the services provided by physicians, as this information is used to determine the physician fees and ensure compliance with billing regulations and payer requirements.
Payer fees, on the other hand, are the amounts that insurance companies or payers agree to reimburse healthcare providers for the services rendered to their insured members. Payers have their own fee schedules, which outline the maximum allowable amounts they will pay for specific services. Medical coding specialists need to be familiar with payer fee schedules to ensure that claims are submitted within the allowed amounts and are compliant with payer guidelines.
In summary, medical coding is essential for accurately documenting and coding the services provided by physicians, which in turn impacts the fees they can charge. Knowledge of payer fee schedules is necessary to ensure that claims are compliant with payer guidelines and reimbursement is obtained for the services rendered.
I hope this explanation helps clarify the relationship between medical coding, physician fees, and payer fees in the compliance process. If you have any further questions, feel free to ask!