In the medical billing process, what is the purpose of reviewing?

In the medical billing process, the purpose of reviewing primarily involves checking the electronic medical record (EMR) for correct codes. This step is critical because accurate coding is essential for proper insurance reimbursement. When medical coders or billers review the EMR, they ensure that the codes used for diagnoses and procedures align with the documentation provided by healthcare providers. Correct coding minimizes the risk of claim denials and delays in payment, ensuring that healthcare providers receive appropriate compensation for their services.

Other processes, such as summarizing patient treatment, preparing billing statements, and collecting outstanding payments, are important; however, they follow the initial crucial step of reviewing codes for accuracy. Without this review, subsequent actions may lead to errors, potential financial losses, and complications in billing.