What is an entity code in medical billing

What is an Entity Code in Medical Billing?

In medical billing, an entity code is employed to recognize the type of entity billing for the solutions. The practitioner, billing office, and payer can all allocate entity codes. If the incorrect entity code is used, the incorrect entity may be billed, experiencing trouble with Medicare and Medicaid. Each entity utilizes its code, and it is critical to use the correct code when billing. If you are uncertain which entity code to use, you can always seek assistance from the medical service provider, payment processing office, or payer.

Unfortunately, entity code errors on claim denials are not among the easier unanswered questions to solve.  If you want to know in details, what is an entity code in medical billing, read the blog.

Before delving into the specifics of medical billing and coding errors, let us first look at the entities that provide medical billing services.

Entities in Medical Billing

To get the detailed information regarding what is an entity code in medical billing. It’s important to know about the entity. An entity is commonly defined as an individual or thing with an independent existence, such as an individual, a corporation, or a local company. If you outsourcing medical billing  to a reliable company, you can get accurate entities in medical billing.

That is why the topic of “entity” errors is so perplexing for healthcare billing, who constantly striving to resolve issues with a claim rejection or denied claim.

If we talk about billing entity, it refers to any relationship, limited liability company, or well-defined entity involved in the medical billing process, either explicitly or implicitly. It contains information from health facilities, patients, doctors, insurance firms, etc. This information helps in receiving patient payments for managing medical billing.

Prior to providing medical billing services, a healthcare center emphasizes gathering and validating each entity’s information. After reading this article, you will hopefully have a detailed knowledge about what is an entity code in medical billing?

Critical Role of Medical Coding In Healthcare

What is an entity code in medical billing

What is an entity code in medical billing? The answer is associated with medical coding in healthcare.  Medical billing company in the medical coding department use ehr software or electronic medical records technology to keep track of patient health records and obtain payment for services provided by health specialists.

To maintain the records up to date, medical coding specialists enter the codes for diagnosis and treatment received by patients and a catalog of completed processes. Medical centers, hospitals, and rehabilitation facilities usually employ these specialists.

Despite being in charge of data management electronically, some healthcare facilities may still require them to fill out paper forms. A medical coder’s most important task is ensuring that coding is accurate so billing and health information can be updated properly.

Accurate information is required to ensure that patients receive appropriate care and that insurance providers can process claims. They must also focus on ensuring the data’s security and confidentiality. Medical coding specialists must also learn about security measures to ensure compliance and protect patient information.

Furthermore, the following obligations are listed for medical coding:

  • Examining medical records
  • Choosing the appropriate code for a patient record
  • Insurance providers are obligated to use codes.
  • Interaction with health care specialists and an assistant to facilitate information accuracy
  • Keeping track of patient details at each visit
  • Keep track of coded data.
  • Maintain patient information security and privacy.
  • Check the accuracy of records and reports.
  • Assign codes for diagnostics and therapeutics.
  • Follow up on code updates frequently.
  • Consolidate and evaluate patient data for future research

Why Entering Correct Code In Medical Billing Is Significant?

Correct coding is important to clear claims and bills amount. Too many delays result in a healthcare system that is inadequate and slow to respond. If the code is inaccurate, the insurance carrier may deny the claim, increasing the patient’s financial strain.

Regardless of the complexity and magnification of each medical procedure, any medical information delivered can start generating paperwork and information that the Best medical billing company must properly process. Working staff is employed in medical billing and coding companies to see all these discrepancies.

Entity Code Error Leads To a Medical Claim Denial

Recognizing the entity code error and correcting the claims is probably the most challenging and complicated task for medical billers. Because of its uncertainty, this methodology involves medical billers spending significant time identifying the actual issues with the claims. Consequently, they frequently fail to submit and appeal claims to payers within stipulated time frames. It leads to a significant revenue decline for healthcare professionals and has a negative impact on their bottom line.

Entity-related errors in coding and claims

Entity related errors may occur in coding and claims. Below are few of its examples.

Patients Member ID

Inconsistencies with this reference usually indicate missing details, and the entity is the patient. If the data can be correctly managed to enter into the claim, the issue may be that the patient’s insurance has changed, and they are not covered on the date the service can offer; this error can also appear if their ID cannot match with their system.

Unidentified ID

This code necessitates using an entity code; in this case, the medical service provider can check each box of the claim to determine which entity cannot be identified.

Incorrect Patient Demographic

Medical billing companies can provide precise and reliable demographic data on patients. They can gather information from their payers and send it to the medical billing company.

Solutions for Errors in coding and claim

In the above sections, it’s mentioned what is an entity code in medical billing and entity-related errors. Here are some solutions to avoid errors in entity code and claim

  • Insurance companies use the same NPI and Tax ID on file with payers or insurers for your medical provider.
  • Prior to submitting claims, the medical billing firm can review the information for entity code errors.
  • If they cannot pinpoint relevant information, they can contact the payers directly to find out more.
  • Inform them that you have sent the medical claim via electronic means.
  • If medical service providers have mentioned the wrong patient’s demographics, they can double-check the patient’s eligibility criteria.

Suppose professionals later discover that the claim denial occurred because the patient is recently added to the policy. In that case, they can instantly contact the insurance payer to ensure the patient is mentioned as an active member under the insured’s policy.

Following the negotiated settlement of all concerns with medical claims and the implementation of all necessary corrective actions, insurance companies can validate the claim from medical specialists and rebill the services to resubmit all affected claims.

Dealing with denied claims that come back to haunt healthcare providers from payers is challenging.

Avoid Common Errors with Bellmedex Medical Billing Services

Bellmedex employs an elevated, professional strategy to aid you in avoiding prevalent medical billing and entity coding errors, and when errors occur, we correct them promptly and seamlessly. If you are facing entity code errors, hire a reliable company like BellMedEx to get rid of this problem. Our experts are well aware to submit accurate claims using perfect entity coding to prevent any discrepancies.

A Growing Need for Medical Coding Specialists

From this article, you get a complete insight into what is an entity code in medical billing. And which errors occur in the medical billing process due to entity code.

Suppose you’re curious to know why medical coding is a viable option. In that case, you should know that with the rapidly increasing demand for healthcare facilities, medical coding is a high-demand profession. It is expected to exceed other occupations in terms of growth. As the healthcare industry evolves, you can have the chance to learn and grow your business as long as you stay current with the most up-to-date technology.

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