Importance of Medical Coding for Insurance

With health and diseases becoming a major issue these days around the world, it has become A LOT more important to have more and more coders involved in the medical field for insurance. But what is medical coding? A medical coder, clinical coding officer, or diagnostic coder are professionals involved in the health care sector who analyze clinical documents and using proper classification systems, assign standard codes to them. They provide medical coding guidelines and suggestions to help regulate the ways doctors, nurses, and other medical staff provide care for their patients. There are three main types of medical coding:

1) ICD (International Classification of Diseases): These are codes used for describing the cause of illness, injury, or death.

2) CPT (Current Procedural Terminology): These deal with anesthesia, surgery, pathology, radiology, measurement procedures, and new technological changes in the medical field.

3) HCPCS Healthcare Common Procedure Coding System): These include outpatient hospital care, medical aid, and Medicare.

Let us look at some points as to why coding is necessary for the medical field.

DATA SYSTEMS
When the coding is paired with the data systems of the hospitals, a powerful tool is made. By doing so, a large number of data from various hospitals, clinics, and other sources are stored, accessed, and used from one large online data system. This implementation helps in the transfer of any patient’s data from any hospital to another for any medical purpose. This information helps doctors to be more connected and make wiser decisions, especially in cases involving the life and death situation of the patient.

PATIENT CARE

Coding is very much required for reimbursements, which include submitting medical claims with insurance companies and bills between insurers and patients. The transfer of information for bill related purposes requires medical records, patient’s medical needs, lab results, pathology records (if any), and any other related documents. Appropriate payment is possible only when the required diagnostic codes are put in place, which also means to verify in case the medical claim is denied by the insurance company.

REGULATIONS

Medical billing and coding fall under the rules and guidelines of many countries and states. Coders in this field are also responsible for protecting the privacy of the patients and their families. They are supposed to take safeguards to preserve the confidential details concerning the patient and his/her medical background in a safe place. Electronic medical records fall under the International Classification of Diseases (ICD-10) codes issued by the World Health Organization (WHO).

Medical coding analysts are in the front line in healthcare data analytics. They work in many types of healthcare setups and not necessarily in hospitals and clinics. Their valuable service is very functional for research and development in the medical field.

Insurance Agency Lead Scoring

Many insurance agencies have not yet formalized their lead scoring system. This is a worthwhile endeavor for all agencies, and one which should be revisited every year, while tracking the return on investment of their marketing programs.

What is lead scoring? It is a methodology used to rank prospects against a scale, and then assign a value to determine interest level and distribution. For example, let’s say a trucking insurance lead appointment arrives at your agency. This lead is with an owner of 15 power units, they use company drivers, and they are unhappy with their carrier. Perhaps your lead scoring system falls on a 1 to 10 scale, and this lead is scored an 8. What might receive a higher score? And what types of leads are outside of profile, and what score would they receive? Perhaps prospects need to score an 8 to appear on your producer scorecards.

Is the lead distributed to producers by territory? Does your lead handling process vary by type of lead, product or prospect? For example, are commercial leads separated by large and small business, by industry or product? Are benefit leads parsed by groups over and under 50? And does your agency have a tracking system in place to determine how many leads showed for the appointment, moved into the pipeline, received quotes and ultimately convert into new business?

Salespeople, sales managers, producers and other business people often refer to prospects in vague terms such as: new, warm, hot, cold, likely, qualified, etc. These terms do little to better understand a sales pipeline or convey likelihood of purchase to other members of the team. Agencies can consider creating a simple prospect scorecard to resolve this issue and quantify their lead scoring. Formalizing lead scoring offers benefits such as:

Helps Producers create ideal attributes to form a buyer persona
Creates a simple numeric system to leverage your buyer persona
Assigns numeric values to rank your best prospects
Creates a simple qualification acronym to determine likelihood to close

What should be included in a prospect scorecard?

Use a prospect scorecard to quantify your approach to pipeline building. Some attributes of your ideal client might include revenue, growth rate, client type (business or consumer) and market niche. For example, are you targeting companies with $5m to $10m in revenue? Are your best prospects fast-growing firms, trucking companies, manufacturers or consumers?

If you’re selling to consumers, are they high net worth, middle-income, millennials or senior citizens? Are your prospects in a specific niche market such as banking, insurance, biotech, consulting, education, etc.? Create a scorecard with your ideal attributes and a customized qualification abbreviation to help you determine if you’re selling to an in-profile prospect.

Insurance agencies and brokers seeking to get to the next level with their insurance marketing and lead generation, but lacking the internal resources to achieve their marketing goals, can reach out to a proficient insurance agency marketing firm.

How to Select Your Insurance Advisor?

You must opt for a life insurance policy. If your finances allow, you must also get health insurance as well as home insurance. This way you would be able to save yourself from any sudden financial crisis. However, you need the best of persons when it comes to an insurance advisor. In this article, we will take you through five steps to hire the best LIC advisor in Delhi.

1. Always prefer a certified advisor

Your insurance advisor must have proper certification from the Insurance Regulatory and Development Authority (IRDA). This proves that he/she is not there to trick you or fraud you. Moreover, the guidelines laid down by this agency make sure that you are protected on all fronts. If a person is not certified by IRDA, legally he is not entitled to advise people on insurance. He may end up in jail. Therefore, before selecting an agent, make sure that he/she has all the necessary certifications.

2. He must be through with investment solutions

You must understand that insurance agents are much more than just a salesman. They must have a proper understanding of financial planning. They should be equipped with all the necessary information about the financial world, both domestic as well as globally. More importantly, your LIC advisor should have a proper understanding of your family and financial standing. This way he would be able to suggest you the best insurance for you. It is advised that you should first develop a good friendship with the advisor and only then allow him to enter your financial realm.

3. He must have a complete understanding of the product he wants to sell

The insurance advisor must have a thorough knowledge of all the insurance policies that his/her company sells. You should sit down and have a long conversation with him about the pros and cons of various policies. You must understand that every insurance company sells a hell lot of policies. Not all policies are meant for you. Your insurance advisor must suggest you the best policy for yourself after understanding your family and finances.

4. Does the follow-up?

He/she is a cheap insurance advisor if he/she forgets you after you have bought the insurance policy. This is not what a responsible advisor does. Even after you have bought the policy, you may have a hell lot of questions to be answered. He/she must update you about the product premium and all the necessary details to make the best of your insurance.

5. He must help you while fulfilling your claim

When a claim arises, an advisor plays a very important role. He is the sole contact person between the insurance provider and the policyholder. He must understand all the formalities that need to be fulfilled for a successful claim. If your claim is denied there was no point in opting for that insurance policy. A good insurance advisor will stand by you when you need him/her the most.