Medical Billing and Medical Coding

Are Medical Billing and Coding the Same?

Medical Billing and Medical CodingA common question for those pursuing a career in medical billing and coding is whether medical billing and medical coding are the same or two distinct things. Although they are typically lumped together as one, they are in fact two different skill sets. This gets confusing because there is so much overlap between them and someone who works as a medical biller likely also does coding and a medical coder may also process billing. Whether or not the same person is doing both depends largely on the size and type of healthcare facility.

It can become even more confusing as both medical billers and coders must have a good grasp of diagnostic and procedure codes in order to do their jobs. To help clear up some of the confusion, here is a breakdown of each of these very important skills in the healthcare field, how they work together, and the tasks completed by amazing people who call themselves medical billers and medical coders!

Medical Coding Careers

Medical code, using the ICD-10, is the actually the foundation of both medical billing and medical coding. However, the medical coder is the one that is actually assessing the diagnosis given and/or procedure performed during a patient visit with a doctor, nurse, or other healthcare professional. They then have to select the most appropriate procedure and diagnosis code for the situation. Sometimes a medical coder must reach out the physician or other healthcare professional to collect further information to assign the correct code(s) for a patient visit.

In many ways, medical coding is a lot like translation. A medical coder is expected to take a diagnosis or a prescription from a physician and translate it as completely and as accurately as possible using the codes available in the ICD-10 system. Each and every diagnosis and procedure has a code to describe it. Some codes are far stranger than you would think! (Check out this article we published about some crazy ICD-10 codes!) So, the medical coder selects the applicable ones from thousands of codes and then shares them with the medical billers.

After a patient visit, the coder will read through the physician’s report and then break down the various parts of the visit into the corresponding codes. So, first, the type of visit the patient is coming in for will be recorded, then their symptoms, any procedures or tests performed by the doctor or other healthcare professional, and finally the doctor’s diagnosis and any prescriptions given. The codes must be formatted accurately in order to be billed correctly later. Finally, the coder enters the information and the claim is passed on to the medical biller.

Medical Billing Careers

As a medical biller, you will receive information from medical coders and other healthcare professionals in a healthcare facility. Then, you will use that information to bill patients directly or submit bills to a patient’s insurance company for a variety situations including medical equipment, medical or diagnostic services provided, and medications.

The facility that you do billing for will likely have a billing program that you will be expected to use to check, update, and enter patient billing information. You will also follow up with insurance companies as well as patients who are not current on their bills for your facility. You may have to check in with the coders in case of any confusion or discrepancies with the codes they filed.

Often, after entering all information and submitting the claim, as a medical biller you may have to explain charges to patients. You may also need to break down what exactly they need to pay versus what their insurance will cover, how their copay works, and other specifics about their insurance and billing situations.

Going back to a patient visit, we can look at this from the medical billing perspective. When the patient initially calls to make their appointment, the billing process starts. They receive information about why the patient is coming in to see the doctor. These codes tell them the type of visit that it is. When the patient comes in to see the doctor, the coder will send all the information to the medical biller who will then create a claim using all of the coded information. The insurance company will look over the claim and return it. Then, the medical biller assesses it to see how much the patient owes after insurance and then bills the patient appropriately.

Medical Billing and Coding Careers

Oftentimes, a healthcare professional is both a medical biller and a coder. So, they do both sides of the job. This may put more responsibility on the person performing both tasks. However, it is also very possibly easier as it allows for fewer mistakes and less confusion between members of the team.

Accurately handling the financial side of a healthcare facility is a very important task. However, being in a position to support the other members of the healthcare team and help patients can be very rewarding. Because medical billing and coding professionals are needed at all medical facilities, there may be a large variety of employment opportunities available for those interested in pursuing education and a career in this field.

Medical Billing and Coding Training

At Ross Medical Education Center, we offer our Medical Insurance Billing and Office Administration program for those interested in pursuing a career in medical billing and coding. Our instructors have experience out in the field in a variety of capacities and will provide instruction on many areas of healthcare that may be important to your medical coding or billing career. Find out more about our program by visiting the Medical Insurance Billing and Office Administration program page today!

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