Introduction
Medical billing and medical coding are sometimes misconstrued as the same profession since they both demand they have equivalent skill sets and engage in similar activities, yet they pursue radically distinct professional routes. Both occupations represent the administrative and financial sides of the healthcare sector, but there are some significant distinctions between them.
Difference between Medical Coding and Medical Billing
- Both roles deal with the medical records of patients, but medical coders examine the records and assign appropriate codes based on the information provided by medical specialists. The medical codes are then entered into specialized software by medical billers. Coders and billers work behind the scenes at clinics, hospitals, nursing homes, and pharmacies to ensure that insurance companies are billed correctly.
- During his job, the coder seldom contacts patients, but he must connect with healthcare practitioners on a daily basis. The coder must be able to apply over 144000 different codes, which he must then communicate to the medical biller. Medical coding is a technical job that requires the coder to have medical expertise, including anatomy and medical terminology.
- A medical biller audits, processes, submits, and follows up on claims with health insurance companies in order to get reimbursement for the healthcare provider’s services. Medical Billers must engage with patients, medical staff, and insurance company personnel more often. If necessary, the biller will need to communicate with the medical coder. A Biller is responsible for obtaining proper pay from the Insurance Company.
- To properly maximize revenue performance, a Biller must understand medical insurance, the claims process, the appeals process, and the influence on the practice’s income. When claims are filed to the insurance company, billers are responsible for verifying the right billing format, assigning the appropriate modifiers, and submitting the needed documents with each claim.
- Medical coders employ three types of codes:
- Category I: Primary procedures and services are coded under Category I.
- Category II: Codes are used to augment Category I codes for performance measurement.
- Category III codes: These are temporary names for innovative and emerging medical remedies.
These codes inform insurance companies about the services provided to the patient, allowing them to match the code to the patient’s insurance plan and ensure coverage for each therapy. Based on the terms of the patient’s policy, insurance companies subsequently compensate healthcare providers for a portion or all of the services provided. Following coding, the next stage is medical billing. Medical billing is divided into two stages:
- Front-end medical billing occurs when a patient schedules an appointment with a healthcare practitioner and provides their insurance information prior to getting services. This allows medical billers time to validate their insurance and resolve any insurance difficulties with the patient prior to their visit.
- Back-end medical billing happens when billers collaborate with coders to develop itemized forms. These forms serve as the foundation for the insurance claims submitted by the biller.
Medical billers give statements to patients for the remainder of their bills after getting payment for insurance claims.
- Medical billers are responsible for accurate billing and engage effectively with patients and their health insurance companies. They keep all invoices structured and make sure payments are made on time. They speak the coding language and have expertise in reading a variety of medical invoices. Medical coders, on the other hand, do not deal with insurance companies or patients directly. Coders evaluate medical records and assign appropriate codes.
Summing Up
Every activity at a medical office has a corresponding code, making coders’ work crucial.
However, it is the responsibility of both billers and coders to explain the charges and breakdown of the bill. Especially when patients need to understand their payment responsibilities such as co-insurance and co-payments as specified by their insurance company.
Simply put, medical billers and coders collaborate to ensure that physicians and other medical workers get paid on time. This is followed by a regular check-in with the medical insurance. Coding and billing, both require ensuring the money reaches the client’s bank account. Depending on the size of the workplace, it can be done by two distinct employees or by a single person.
