MEDICAL BILLING VS MEDICAL CODING

Medical billing and medical coding are often confused as the same profession because both require similar skill sets and employ similar kinds of tasks, but they are very different career options. Both the professions represent the administrative & financial side of the healthcare industry, but there are some stark differences between the two professions.

Both the jobs deal with the medical records of the patients, but the medical coders review the patient’s records and assign proper codes based on the information provided by the medical staff. Medical billers then use specialized software, into which all the medical codes are entered. Coders and billers work behind the scenes at clinics, hospitals, nursing homes and pharmacies, so that the insurance company is properly billed.

Coders hardly interact with the patients during their careers, but have to regularly communicate with the healthcare providers. Coders should be able to apply approximately 144,000 different codes which they will communicate to the medical biller. Medical coders are high on the technical side, where the coder is required to have medical knowledge, including that of anatomy and medical terminology.

A medical biller audits, processes, submits and follows up on claims with health insurance companies in order to receive payments for the services given by the healthcare provider. Medical billers have to interact more with patients, medical staff and Insurance company staff. The biller will have to interact with the medical coder as well if needed. A biller has to make sure that a proper reimbursement is received from the Insurance Company.

A biller needs to understand medical insurance, claims process, the appeals process and the impact on the practice’s revenue to successfully be able to optimize revenue performance. When the claims are submitted to the insurance company, it is the responsibility of the billers to verify the correct billing format, assign the proper modifiers and submit the required documentation with each claim.

Medical billers are responsible for correct billing, for which they communicate with patients and their health insurance companies professionally. They keep all the invoices organized and ensure payment is done in a timely manner. They are well versed with the coding language and are familiar with deciphering an assortment of medical invoices. On the other hand, medical coders do not work either with the insurance companies or the patients directly. Coders interpret medical records and capture proper codes. Note that every action taken in a medical office has a corresponding code making the work of coders very critical.

However, it is the obligation of both billers and coders to explain the charges and breakup of the bill, especially when the patients need to understand their payment obligations such as co-insurance and co-payments, which their insurance company specifies.

Simply put, medical billers and coders work together so that the physicians and other medical staff get paid timely. This is followed by a regular follow up with the medical insurers in order. Coding and billing are both essential to make sure that the money finds its way to the client’s bank account. It may be done either by two separate people or by a single individual, depending upon the size of the office. When deciding on the best pathway to follow, if the student is new to healthcare or works in the field and is not certified, it is recommended that the CHAA pathway is pursued prior to pursuing CPC or ICD 10.