Keywords

coding, managed care, Medicare, reimbursement

 

Authors

  1. Falen, Thomas MA
  2. Liberman, Aaron PhD

Abstract

This article will discuss the vital link, emerging role, and high financial impact of medical coding to health care reimbursement and managed care. Medical (clinical) coding represents the data requirements needed to support the following:

 

* provider's reimbursement from Medicare and other third-party payers for both inpatient and outpatient services;

 

* sharing clinical data across a network of providers in various health care settings to provide for the continuity of patient care; and

 

* research needed to improve, standardize, and optimize patient treatments to ensure that high-quality care is provided at a reduced cost.