Medical Coding certification course under Ayushman Bharat: Narendra Modi government's ambitious Ayushman Bharat scheme is likely to trigger demand for medical coders soon.
Medical Coding certification course under Ayushman Bharat: Narendra Modi government’s ambitious Ayushman Bharat scheme is likely to trigger demand for medical coders soon. Also, every empanelled hospital under the scheme, or others adopting e-Claims, may soon have to appoint at least one person in their team who has completed a government-approved certification in medical coding.
The Joint Working Group of IRDAI and National Health Authority (NHA) has recommended the government to create a certification course in Medical Coding and ensure that hospitals have at least one person in their team who have completed the course before they can adopt e-Claims.
E-Claims for all
The JWG has also recommended the adoption of a standard e-Claim form which could be used for any health insurance claim – be it public (PMJAY, CGHS) or Private (Retail/Group). It said that that e-Claim would be based on FHIR 4 standards, which is used globally.
Movement towards low-cost paperless ecosystem is apparently on the agenda of the government. As a step in this direction, the JWG has recommended the creation and adoption of Health Claims Platform (HCP) and standardization of e-claims and other related documents.
Why medical coding course?
Role of certified medical coders would be crucial for making successful adoption of e-Claim. The NHA-IRDAI document has proposed to use ICD 10 for coding of diagnosis and ICD 10 PCS for coding of procedures. It said, “Accurate medical coding is key to good auto adjudication and fraud waste and abuse management.”
“The roll out of technology must be accompanied by capacity building in areas where resource training/knowledge are currently weak. This committee recommends the creation of a certification course in medical coding. It should be mandatory for every healthcare provider to have at least one staff of the hospital who has completed the medical coding course.”