Front Office Procedures

Front Office ProceduresCoding and InsuranceCoding consists of . . . Diagnostic CodingProcedural Coding

What is Diagnostic coding??? Coding is converting verbal or written descriptions into numeric designations

For example:784 is the diagnostic code for. . .

Headache Ouch!

Headache! This is how it works-An insured patient goes to see his doctor for a headache.

Then Doctor X gives the headache a code number (784)

And sends the proper paperwork to the patients insurance company with that code number.Coding . . .yeah!ABC Insurance company receives the paper work with the code: 784For the patient and one look at the number tells ABC Insurance company that their insured was seen for a 784Or. . .OUCHA Head Ache!

Procedure codesMr. Bean has seen Doctor X several times over the last three years, this makes him an. . . ESTABLSIHED PATIENT

Procedure codesMr. Bean saw Doctor X for a short visit about 15 minutesAnd he only had one problem to discuss with the doctorMr. Beans visit was a problem focused, limited exam

Procedure codes yippee!So Doctor X sends this information to Mr. Beans Insurance company as well, in the form of a number.This number is for the procedureIt is called a Procedure Code

99212

Codes, codes, codesOnce ABC Insurance Company receives the paper work, called a claim, they review the code numbers and . . .

Codes, codes, codesDecide what to pay Doctor X

Amount due:Doctor X bills ABC Insurance Co.$175.00 for an office visit

ABC Insurance Co. only has to pay Doctor X a portion of that amount.They decide to pay. . .payment$75.00

Everyones happy

BecauseThe doctor gets paid.The patient only has to pay a small amount of money to see his doctor- this is called a Co-pay.

Everyone is happyABC Insurance will continue to receive monthly amounts of money from Mr. Bean- this is called a premium.AND- Mr. Bean has already paid his deductible, which is an amount of money that Mr. Bean has to pay every year towards his Insurance claims.

Recap-Mr. Bean pays a small amount out of his paycheck every month so that when he goes to see his doctor, Doctor X, he only has to pay a vary small amount called a co-payment.

Doctor Xs office collects the co-payments from their patients, like Mr. Bean and the monies collected from the Insurance companies and this is how the office makes money

Insurance codingThe End.