Difference Between Medical Coding and Billing

It is often mistakenly assumed to be the same thing, but medical billing and medical coding are two very distinctly separate jobs. While there are many similarities between the two and small healthcare facilities can entrust a single person to perform both tasks; most medium and large healthcare facilities have different individuals 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 take a look at the responsibilities of the two job profiles.

Medical coding

Medical coding is concerned with assigning the relevant code to the various treatments given to a patient, to facilitate their insurance claims. Medical coders review the patient’s medical records to determine the procedures performed on the patient by the physician, surgeon, nurse, and other members of the healthcare team. They review the doctor’s transcripts, lab test results, and other documentation related to the patient’s treatment. If no further details or clarification are needed, the medical coder assigns the appropriate diagnosis or procedure code for the corresponding service provided to the patient and creates the claims to be paid by the insurance company. The 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 important that the medical coder is accurate in the coding process as this data is used by insurance companies when processing patient claims. Medical coders often need to communicate and coordinate with other healthcare and staff members to collect more data about the patient’s treatment or inform them of the type of data and information needed in the patient’s medical record to ensure that the encryption process is smooth and efficient .

Medical billing

Medical billing is concerned with checking the assigned medical codes and sending the claim. Using special software developed to enter the codes assigned by the medical coder, as well as other pertinent insurance information, the medical bill holder forwards the insurance claim to facilitate payment. After the insurance claim is forwarded, the medical bill holder remains in contact with 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 account holder must liaise between the patient and the insurance company to resolve the matter and resubmit the claims with any necessary adjustments; if required by the insurance company.

Medical account holders often have to explain the benefits and answer questions about their insurance when they get the insurance information from the patients themselves. They are also responsible for clarifying any questions about charges on the bill, should the patient ask. The medical bill holder is also responsible for explaining deductibles, co-payments, and co-insurances that an insurer requires, in case the patient wants to know why they still have to pay despite being covered by insurance. At the same time, medical account holders should know the claims process and be familiar with all the requirements that must be submitted in order to process a claim. It is their job to ensure that the correct billing format is followed, all questions are answered correctly and all supporting documents are attached before the claim is handed over to the insurance company.

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Medical account holders also have to make sure that the insurance companies pay the doctors and the healthcare facility for the services provided to the patients.

Common grounds

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