July 12, 2024

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Difference Between Medical Coding and Billing

Difference Between Medical Coding and Billing

Often mistakenly assumed to be the same, medical billing and medical coding are two very distinctly separate jobs. Although there are many similarities between the two and small healthcare settings may entrust a single person for doing both the tasks; most medium and large healthcare facilities have different individuals responsible for the two different jobs. Both these jobs come under medical records and health information technicians. In order to understand the differences between medical coding and medical billing, let us 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 study the patient’s medical records to determine the procedures performed on the patient by the doctor, surgeon, nurse and other members of the healthcare team. They check the doctor’s transcriptions, laboratory test results and other documentation relating to the patient’s treatment. If no further details or clarification is required, the medical coder assigns the correct diagnosis or procedure code for the corresponding service given to the patient and creates the claims to be paid by the insurance company. The codes are assigned using the 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 for the medical coder to be accurate in the coding process as this data is used by insurance companies when processing patient claims. Medical coders often have to interact and coordinate with other healthcare and staff members to either gather more data regarding the patient’s treatment or to inform them regarding the type of data and information required in the patient’s medical file to ensure that the coding process becomes smooth and efficient.

Medical Billing

Medical billing is concerned with checking the assigned medical codes and transmitting the claim. Making use of special software developed to input the codes assigned by the medical coder as well as other relevant insurance information, the medical biller forwards the insurance claim to facilitate the payment. Once the insurance claim has been forwarded, the medical biller continues to be in touch with the patient and the insurance company to ensure that the claim has been paid. In case of delays, rejected or denied claims, the medical biller needs to liaison between the patient and the insurance company to sort out the matter and resubmit the claims with necessary adjustments; if required by the insurance company.

Medical billers often have to explain the benefits and answer questions regarding their insurance when they get the insurance information from the patients themselves. They are also responsible to clarify any queries regarding the charges on the bill, should the patient ask for it. The medical biller is also responsible to explain deductibles, co-payments and co-insurance that an insurer requires, in case the patient demands to know why they still need to pay despite being covered under insurance. At the same time, medical billers have to know the claims process and be familiar with all the requirements that have to be submitted to process a claim. It is their job to ensure that the correct billing format is followed, all questions properly answered and all supporting documents attached before handing the claim to the insurance company.

Medical billers also have to make sure that the insurance companies pay the doctors and the healthcare facility for the services rendered to the patients.

Common grounds

It is important that both medical coders and billers pay keen 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 staff, patients and insurance representatives. It is most important that both medical coders and billers possess integrity as the law requires that patient data is to be kept confidential.