To those who do not work in healthcare, medical coding and medical billing are often thought to be interchangeable roles. While their functions do intersect, these jobs have several key differences. In short, medical coders translate a clinician’s diagnoses or patient procedures into a numeric or alphanumeric code and assign that code to medical records. Medical billers then include the information from medical coders and use it to submit claims to insurance agencies.
Both roles act as a liaison between healthcare providers and insurance agencies, ensuring that providers are paid for their services. In both roles, compliance is key in confirming that providers are accurately and ethically billing patients. Let’s clear up the differences between medical billing and medical coding:
What is Medical Coding?
Medical coders translate a patient’s medical information documented by the provider (diagnoses, complications, procedures, treatment) into billable, industry-recognized alphanumeric/numeric codes. These codes are then compiled on to a claim, which is sent to the medical biller for transmission. These codes serve as a standardized language within the healthcare industry, allowing seamless communication between healthcare providers and insurance agencies. Medical codes streamline patient information across various organizations by replacing the need to sift through patient documents with concise codes, simplifying the exchange of medical details.
Additionally, coding plays a crucial role in helping financial teams understand why patients receive specific treatments and services which providers seek reimbursement for. Healthcare organizations use medical codes to quantify the services provided when billing patients and insurance companies. The accuracy of these codes is critical in obtaining appropriate revenue by ensuring that practitioners get paid for all the services they provide.
What is Medical Billing?
Medical billers are a liaison between patients, healthcare providers, and insurance agencies and arrange for reimbursement of healthcare services. Medical billers are responsible for creating, submitting, appealing, and following up with insurance claims for reimbursement purposes and often communicate directly with patients regarding payment. Medical billers can work for insurance companies, hospitals, private physician offices, and clinics. From handling insurance claims, making phone calls to insurance companies, and contacting patients with billing questions or concerns, medical billers also play a crucial role in the revenue cycle of healthcare practices.
What Certifications are Needed to Become a Medical Coder or Medical Biller?
Certifications may be dependent on the state you live in or the employer you are working for. Additionally, depending on your desired career trajectory, you may choose to earn your certification in a specialized area of medical coding or billing, such as inpatient coding, risk adjustment coding, or outpatient coding.
If your healthcare organization is looking for healthcare coding and billing support, explore how Maxim Staffing can help you find the best candidates.