Do medical coders have to talk to the public or patients?

In this age, medical coders’ clear communication with patients before, during, and after coding plays a massive role in streamlining revenue cycle management (RCM) through customer relationship management (CRM). Gone are the days when this interaction was not significantly important, but now, coders and patients necessitate communication with each other due to the myriad of advantages that this interaction provides not only to coders but also to patients and healthcare providers. To begin with, effective communication and interaction can help to improve patient satisfaction. By actively engaging with the patient and explaining the coding process, medical coders can help to alleviate any concerns the patient may have. This can lead to a more positive patient experience, which is vital for both the patient and the healthcare provider.

When patients feel they are being heard and understood, they are more likely to be forthcoming with important information and follow treatment plans. This can lead to better outcomes and a more positive experience for the patient. In addition, good communication and interaction can help to prevent medical errors. If medical coders cannot obtain all of the necessary information from patients, they may make mistakes in coding or documentation that could have serious consequences. In contrast to five, 10, or even more years ago, when you might not have required a strategy for addressing patient coding problems, you most definitely need one; the approach you choose should involve interactive and communicative coding employees. Those medical organizations that do not facilitate patient and coders interaction will somehow compromise the financial status of their practice. Keeping this in mind, this post will clarify the concern of any interaction between medical coders and patients and answer the question do medical coders have to talk to the public or patients.

Some particular situations where medical coders have to talk to the public/patient

Improving a medical specialties financial experience is the fundamental key to medical practice’s revenue cycle management success, according to the Senior Regional Director of Revenue Cycle at Ascension Healthcare. Medical coders are integral to the healthcare industry’s revenue cycle management (RCM) team. A skillful coder helps healthcare facilities, insurance payers, and patients navigate the complexities of the many laws, regulations, and guidelines related to the business side of healthcare.

Although medical coders work behind the scenes and interact directly with healthcare providers and insurance companies, they have to interact with patients. Hence, the answer to your question, “do medical coders have to talk on the phone?” is yes. Let’s discuss certain conditions when medical coders using CRM systems interact with patients to eliminate confusion.

When reviewing medical records?

Medical coders may have to review a patient’s medical records to ensure that all necessary information is included and accurately coded. This may involve asking the patient questions about their medical history or treatment. It may also include their personal information such as their name, number, date of birth, address, etc.

When explaining coding or billing procedures?

Medical coders may need to explain to patients how their medical treatment will be coded and billed, especially if the patient has questions or concerns about their insurance coverage or out-of-pocket expenses.

Billing and payment issues

Suppose there are any discrepancies in the billing or payment for the medical services received by the patient. In that case, the medical coder may have to communicate with the patient to explain the EOB and resolve any issues. This may involve discussing the charges, coverage, and payment.

Payment arrangements

If the patient cannot pay the total amount due on the EOB, the medical coder may need to speak with the patient to discuss payment arrangements or options for financial assistance.

Resolution of billing errors

If the Explanation of Benefits shows incorrect charges or errors in the billing process, the medical coder may need to speak with the patient to resolve the issue and ensure that the correct charges are billed and paid.

Explanation of insurance coverage

If the patient has questions about what their insurance covers or how much they are responsible for paying, the medical coder may need to explain the EOB and insurance coverage to the patient.

Ensuring proper documentation

They ensure that the patient’s medical record is complete and accurate. A medical record is an essential tool for healthcare providers, as it provides a comprehensive overview of the patient’s medical history, current condition, and treatment plan. If the medical record is incomplete or contains errors, it can lead to misdiagnoses, inadequate treatment, and other adverse outcomes.

Auditing

This interaction may be necessary for auditing purposes, such as when a payer requests additional information to verify the accuracy of a claim. Medical coders should be professional and respectful when interacting with patients for auditing purposes and adhere to all applicable laws and regulations regarding patient privacy and confidentiality.

Denial appeals

If an insurance company denies a claim for medical treatment, medical coders may need to work with patients to gather additional information or documentation to support an appeal. This may involve discussing the details of the claim with the patient and working with them to provide any necessary documentation to help the appeal.

Who should answer when your patients have medical coding questions?

The days of patients accepting medical bills without question are long gone, as they now carefully review them in light of rising out-of-pocket costs. In an attempt to streamline interaction, healthcare companies are likewise stepping back from offering a great degree of information on patient statements. As a result, the patient needs to call for billing clarity whenever they have questions. And if the queries are about coding, then confusion and doubts are natural. But it raises the issue of whether your coders should interact directly with patients to answer their queries. The solution depends on critical points and elements, some of which are mentioned here.

What’s the question?

To provide predetermined answers for standard and common questions, coders are not usually supposed to be involved and talk to patients. But in the case of complex questions, the most obvious idea is that calls demanding a thorough evaluation of the coding or a thorough clarification should be referred to and handled by a medical coder. So, a medical coder talks to the patient for complicated questions to answer.
Some examples of such questions are:

• Was the coding accurate to start with?
• Does the diagnosis code need to be amended, or did the doctor input it incorrectly?
• Did the payer make such a mistake?
• Is the amount for the patient accurately displayed in the statement?

Involving a coder in such situations prevents the probability of the facts being mistranslated. Failure to do so may cause the patient to become frustrated and confused, resulting in their calling again to address the same problem, and also in terms of money and patient satisfaction, which is expensive.

What’s the process?

Direct communication occurs when patients need a coder’s attention for particular processes. Issues are sent to coders for evaluation, documentation, and monitoring to guarantee a precise solution. Inform the patient that it may require some time for you to check the medical records and do some research about the issue.