The complex, highly-charged process of converting healthcare you receive into a dollar amount has generated not just decades of heated political debates but also a standard way of recording healthcare activities and health information. Have you ever received a bill from your doctor and seen weird codes like 99201 or R05.9 next to the descriptions of your visit? These codes are captured on something called billing claims. Billing claims first purpose is to justify a request for payment from an insurance company for providing healthcare, but they also offer a vast and often untapped source of healthcare data.
Using internationally standard codes called “ICD-10”, billing claims can capture past medical history like tobacco use, current healthcare needs like symptoms or accidents, and procedures from sutures to organ transplants. These codes explain and justify why certain care was provided to a patient. Additional codes called “CPT codes” offer a bridge from that situation and care to standard activities with associated financial charges.
So why should you care about this, besides trying to understand your next medical bill? These claims can be used to track everything from opioid overdoses to impacts of a medical food nonprofit program. If you work anywhere in the health, wellness, or healthcare space, understanding exactly what claims data contain and can offer you is critical. And even if you don’t – governments, companies, and nonprofits across the county are using these claims are being in research, policy, and more. If you want to better interpret and be aware of the benefits and limitations of this rich datasource, this podcast will help answers your questions.
If you’re ready to jump into claims data, be sure to tune into an upcoming episode on state all-payer claims databases.
Lindy Nichols is a Certified Professional Coder for the Denver Health and Hospital Authority in Denver, Colorado. Her decade of experience in the medical coding space combined with her approachable discussions make her a fabulous resource to understanding the power – and danger – of claims data.