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Difference Between Medical Billing and Medical Coding

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There is no doubt that medical billing and medical coding professionals play an essential role in the reimbursement cycle. This helps ensure that healthcare providers in the US get paid accurately and timely for the medical services they offer. Also, keep in mind that since medical billers and computer assisted coding vendors share a close and interdependent working relationship in the healthcare industry, educational programmes tend to combine both topics into a single programme.

If you are interested in training for medical coding and billing career opportunities, you will be happy to know that it is a growing and rewarding industry, offering you the potential for a satisfying and fulfilling career path. You will also find this Free Medical Billing and Medical Coding Study Guide very useful.

You may know that medical billers and coders work with patient records and information in medical offices. It is worth noting that a medical coder reviews patient records, such as insurance information, and applies the appropriate medical codes to the claims. These claims are then sent to various insurance firms for payment. 

On the other hand, a medical biller is responsible for transmitting the adequately coded claims to the relevant insurance providers and follows the claims processing until the provider receives payment. Medical billers also examine insurance claims for completeness, verifying that every medical service and supply is appropriately accounted for.

However, contrary to popular belief, medical billing and medical coding are two separate and different professions. Also, note that often these individuals work in two distinct areas. Did you know that in a small medical office, one individual or a group of individuals may be responsible for the medical billing and medical coding functions?

Medical coding defined 

According to the American Association of Professional Coders, medical coding is the practice or process of translating medical reports, such as diagnoses, into a code used in the healthcare industry. It is worth noting that a medical coder works specifically with the technical and financial aspects of the medical world.

Keep in mind that they check patients’ medical records, along with other information, such as doctors’ notes, possible diagnoses, and records of testing. 

In a way, medical codes tell a sort of brief story about a patient’s visit. Whether a doctor saw a patient for a routine check-up or ordered an MRI scan for a work injury, note that each medical procedure and service receives a specific code.

Why medical coding matters

Note that medical coding matters as the information this process generates can be put to use in several ways. For example, it is worth noting that medical coding data can be assessed and analysed for use in health research and healthcare policy development. More importantly, perhaps, medical coding is the basis for the important medical billing function in most organisations.

Medical billing defined 

Medical billing, on the other hand, is the process or practice of submitting medical claims and following up on them with health insurance firms to receive payment for services provided by a healthcare provider. 

A medical biller uses medical records in order to ensure that facilities and providers get reimbursed appropriately and also in a timely fashion. Did you know that a medical biller is also expected to audit and submit medical claims for each patient’s diagnoses as well as the medical procedures that physicians and nurses perform?

With the help of special billing software that medical coding experts have translated and keyed into the system, medical billers communicate directly with medical professionals, patients, and insurance companies responsible for paying bills. Apart from entering information about medical treatments into billing software, billers communicate with providers and patients to follow up on claims as well as payments.

Why medical billing matters

It is no secret that medical billing is important to the US healthcare industry. This is because it helps ensure payments flow in a timely and consistent manner from insurers to healthcare providers. Also, keep in mind that healthcare providers, such as doctors, and insurers usually negotiate agreed-upon billing rates for specific medical procedures as well as set contractual terms and conditions for payment deadlines. 

A medical billing professional helps keep all parties to the transaction compliant with the terms and conditions of these contracts.

You will be happy to know that outsourced medical billing companies, like UControlBilling, take control of all aspects of the billing process. As they are experts in their field, they spend considerable time and resources perfecting processes. 

Key differences 

Involvement with patients

Did you know that medical billers usually work closely with patients? In contrast, medical coders usually do not. You may know that working with patients in a hospital or clinical setting is not for everyone. You will be happy to know that there are several jobs in the healthcare sector where you can actually help patients without working with them directly. And medical coding is one of those positions.

So, medical coding professionals work behind the scenes, collaborating with physicians, nurses, billers, and other medical staff.

On the other hand, medical billers must communicate effectively with patients. This is why you need excellent communication skills to be a medical biller. There are times when things do not always go smoothly and seamlessly. 

So, as a medical biller, it is your responsibility to act professionally as well as empathize with patients who are not always thrilled or happy to discuss costs that they never expected to cover. It is worth noting that effective medical billers help patients fully understand their medical charges and are, hence, an integral element of the overall healthcare experience.

Where they work

You may know that medical billers and medical coders work in many settings, such as physician offices, nursing homes, hospitals, insurance firms, and dental offices. Typically, you will find them behind the scenes at hospitals, clinics, and nursing homes. However, note that they may also find employment in pharmacies. Because of such a wide range of possible employers, note that it is an excellent opportunity to find a rewarding career close to home!

As most of the work is now done on computer systems and mobile devices, many medical billers and coders can also work from the convenience and comfort of their homes at least once or twice a week. However, it is worth noting that you need experience before this can happen. This is why medical billing and coding can be an ideal choice for people seeking a more flexible work environment.

Autonomy vs Alliance 

You can consider medical billing as an autonomous role. On the other hand, medical coding is an alliance role. This is because medical coders usually work directly for various healthcare organisations, such as nursing homes, in alliance with physicians, nurses, administrators, and other healthcare employees.

In contrast, medical billers tend to work more autonomously and facilitate communication between the various parties in order to streamline the billing process. This is why medical billing can be the most suitable starting point for innovative and entrepreneurial-minded people interested in climbing the ladder and advancing their careers in the healthcare administration field.

Why personality matters

You should know that jobs in medical billing or coding often require unique personality types. So, if you tend to self-identify as more introverted or extroverted, you will be better off leaning one way or the other.

For example, if you are an extrovert, you might prefer a job in medical billing. This is because medical billers have to be comfortable and relaxed on the telephone talking with insurance companies and patients. They should also be able to communicate clearly with many people while smoothly resolving issues when needed.

If you are an introvert, you will likely be more comfortable as a medical coder. This is because medical coders more often perform their daily work on their own, sometimes collaborating with other healthcare and medical staff. 

This makes it a better career option for analytical and detail-oriented students not comfortable with the idea of speaking to people all day.

Your earnings depend on where you work

Would you like to work behind the scenes in a medical office or home office setting? If so, medical billing and medical coding could be a great option for you. It is worth noting that the medical billing and medical coding career outlook looks promising and brighter than many other career fields.  You will be pleased to know that there are growing employment opportunities in numerous settings, including hospitals, clinics, insurance and pharmaceutical companies, and nursing facilities.

Here is another big perk. Medical billing and coding education programs usually do not take long to complete. Also, you can complete your education online as well if you wish.

Note that medical coding and billing salaries tend to differ based on education. And higher degrees can earn you better salaries. Your earnings may also vary depending on your employer. This is because some employers pay more compared to others. According to the BLS, insurance carriers usually pay $53,530 a year, while junior colleges pay $91,900 a year.

Final thoughts 

As you can see, medical billers and coders are essential to the reimbursement process. They can have a massive impact on a health provider’s bottom line. However, keep in mind that they have different tasks and responsibilities.

Ellen Diamond did her degree in psychology at the University of Edinburgh. She has an ongoing interest in mental health and well-being.

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