Medical Coders employ established methods to assign a code to a patient’s record, making it easier for insurers to determine what kinds of services are covered under a patient’s plan. Medical coders also collect paperwork to substantiate their coding decisions and to defend against any claims that have been unfairly refused. They examine all aspects of a patient’s visit, including diagnostic tests, consultations, in-office treatments, and medicine administered.

Through this course, the prospect students will cover medical coding principles relating to the three major code manuals:  ICD-10-CM, CPT® & HCPCS Level II (2023). Medical Coders work in hospitals, clinics, and other healthcare settings to help patients and insurance companies collaborate. They spend the majority of their time reading patient files and updating them manually using medical codes.

Reviewing outpatient documentation for accuracy to support coding, quality measures, and clinical requirements. CDEO professionals provide feedback to providers to improve clinical documentation and facilitate ongoing documentation improvement to meet all requirements of the medical record. To become a CDEO, documentation professionals must demonstrate knowledge of pathophysiology, coding and billing guidelines, and quality measures. Training for a CDEO accreditation will prepare you to review medical documentation for accuracy and to communicate and properly notify of possible documentation deficiencies and will prove you have a complex understanding and application skill to correctly code using CPT®, ICD-10-CM, and HCPCS Level II coding systems.

A risk adjustment coder main role is to provide proper identification of patient’s health records conditions in order for health plans have appropriate payments to cover care. Through assigning appropriate ICD-10-CM codes adhering to risk adjustment models, auditing inadequate, ambiguous or unclear coded records, and complying with the standards of ethical coding set by the American Health Information Management Association, Medical coders stand as a valuable asset for any Healthcare provider. Certified Risk Adjustment Coders Understand medical coding norms and regulations in depth, including compliance and reimbursement, as well as the influence of diagnosis coding on risk-based payment models.

Medical auditing is a crucial component of successful and compliant doctor operations, over time, more doctors want to routinely perform audits as today the risks of not following coding and documentation rules are simply too costly. As a CPMA, you will be able to apply your expertise to ultimately enhance the revenue cycle of any healthcare providers. The reporting of medical services is subject to stricter regulations, CPMAs are trained to be aware of the signs that an institution could not be in compliance, assists providers in avoiding any possible liability and obtaining appropriate payment for the patient care they offer.