What should a billing and coding specialist verify before submitting a claim?

Verifying the patient's insurance status before submitting a claim is critical for the billing and coding specialist. This step ensures that the patient is covered under the correct insurance plan, which can significantly impact whether the claim will be accepted or denied by the insurer. Understanding the patient's insurance status helps the specialist determine the appropriate codes to use, the patient's financial responsibility (like copayments or deductibles), and ensures that the services rendered are included within the scope of the patient's coverage. Any errors in this area can lead to delays in payment, denials, or the need for resubmission of claims, which can be time-consuming and costly for both the healthcare provider and the patient.

While verifying the provider's credentials, appointment time, and the integrity of medical records are important tasks, they do not directly impact the initial acceptance of a claim as significantly as confirming the patient's insurance status.