Often mistakenly assumed to be the same thing, medical billing and medical coding are two distinctly separate jobs. Although there are many similarities between the two, and small healthcare settings may have one person perform both tasks; most medium and large health facilities have different people responsible for the two different jobs. Both jobs fall under Medical Records and Health Information Technicians. To understand the differences between medical coding and medical billing, let’s look at the responsibilities of the two job profiles.

medical coding

Medical coding deals with assigning the corresponding code to the different treatments given to a patient, to facilitate their insurance claims. Medical coders study the patient’s medical records to determine the procedures performed on the patient by the physician, surgeon, nurse, and other members of the health care team. They check doctor’s transcripts, laboratory test results, and other documentation related to the patient’s treatment. If no further details or clarification are required, the medical coder assigns the correct diagnosis or procedure code for the corresponding service provided to the patient and creates the claims to be paid by the insurance company. Codes are assigned using Current Procedural Terminology (CPT) for procedures received by the patient and the International Classification of Diseases (ICD) for the physician’s diagnosis of the patient.

It is extremely critical that the medical coder is accurate in the coding process, as insurance companies use this data when processing patient claims. Medical coders often have to interact and coordinate with other healthcare and staff members to collect more data about a patient’s treatment or to inform them about the type of data and information needed in the patient’s medical record to ensure that the process coding smooth and efficient. .

Medical billing

Medical billing deals with verifying assigned medical codes and transmitting the claim. Using special software developed to enter the codes assigned by the medical coder, as well as other relevant insurance information, the medical biller submits the insurance claim to facilitate payment. Once the insurance claim has been submitted, the medical biller continues to contact the patient and the insurance company to ensure that the claim has been paid. In the event of delays, rejected or denied claims, the medical biller should be the liaison between the patient and the insurance company to resolve the matter and resubmit claims with any necessary adjustments; if required by the insurance company.

Medical billers often have to explain benefits and answer questions about their insurance when obtaining insurance information from patients themselves. They are also responsible for clarifying any doubts about the charges on the invoice, in case the patient requests it. The medical biller is also responsible for explaining the deductibles, copays, and coinsurance required by an insurer, should the patient demand to know why she still needs to pay despite being covered by insurance. At the same time, medical billers must be familiar with the claims process and all the requirements that must be met to process a claim. It is your job to ensure that the correct billing format is followed, all questions are answered correctly, and all supporting documents are attached before submitting the claim to the insurance company.

Medical billers must also ensure that insurance companies pay physicians and the health care facility for services provided to patients.

common motifs

It is important that both medical coders and billers pay close attention to detail and ensure that codes and all other insurance data entered into the system are accurate. Both jobs require interpersonal skills as they deal with healthcare personnel, patients, and insurance representatives. It is very important that both medical coders and billers have integrity, as patient data is required by law to be kept confidential.