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Let’s understand the differences between medical billing vs. medical coding. Discover the role of each one in a healthcare organization.

When you visit a doctor, get treatment, or undergo surgery, there’s a lot more happening behind the scenes than you might realize. Healthcare professionals handle different operations from scheduling appointments to maintaining patient records. When we hear the word administrative tasks then two of the most crucial elements of these tasks of the healthcare system are medical billing and medical coding. Both of these terms sound similar but in actuality, both serve different purposes.

If you're someone who's considering a career in healthcare administration or just want to better understand how the healthcare system works then it’s important to understand the differences between these two roles. So let’s cover everything you need to know.

What is Medical Billing?

Medical billing is the process of getting a bill for the provided healthcare services whether from patient balances or submitting claims to insurance companies. Medical billers are the ones who make sure that the healthcare providers whether they are doctors, hospitals, or clinics get paid for the services they've provided. They handle the financial side of healthcare by submitting claims to insurance companies. These billers also make sure patients are billed correctly and follow up on payments.

How does it work?

Whenever a patient receives medical treatment, the provider needs to get paid for their services. Medical billers' roles start here as they are responsible for creating a detailed bill that contains the details of all the services provided. This includes doctor visits, surgeries, lab tests, and even the use of medical equipment. The biller then submits this information to the patient’s insurance company which reviews the claim and decides how much will be reimbursed.

In addition to submitting claims, medical billers also handle other important tasks such as:

- Verifying patient information: Before submitting a claim, billers need to confirm that the patient’s details like their insurance coverage are accurate. This stage is called the front end in medical billing services where patient eligibility is verified and pre-authorization of services is requested from insurance providers.

- Communicating with insurance companies: If there are any issues with the claim like missing information or a denial then billers work with insurance companies to resolve the problem.

- Patient billing: When insurance doesn't cover the full cost of treatment, billers generate bills for patients to pay the remaining balance.

- Following up on unpaid claims: Sometimes claims don’t get paid on time and it’s the biller’s job to track down the payment until the provider receives payment.

Medical billing is in actual the final step in the revenue cycle for healthcare providers. Without skilled billers, healthcare practices would struggle to get paid for their services which could affect their ability to stay open and continue providing care to patients. Efficient medical billing services for small practices are crucial for the cashflow.

Roles of Billers

What is Medical Coding?

On the other hand, medical coding includes translating the services provided into a set of codes. These codes are used as a standardized language for billing and reimbursement. The main purpose of these codes is to describe the diagnosis, procedures, and treatments a patient receives during a visit to a healthcare provider. Medical codes act as a translator between healthcare providers and insurance companies. The two main codes such as ICD-10 and CPT are used in the United States. The right use of code shows the right submission of claims. The job of a medical coder is to carefully review patient records and assign the correct code for each service. Here’s a detailed of what a medical coder does:

- Reviewing medical records: Whenever patients visit a doctor, medical coders go through detailed records of patient visits and check for the specific diagnoses and procedures performed.

- Assigning codes: Using coding systems like ICD-10 coders assign the correct alphanumeric codes to each service. This helps insurance companies and healthcare providers understand exactly what treatment was provided.

- Ensuring accuracy: Accuracy is the priority in coding that’s why coders need to be careful about selecting the right codes. If they choose the wrong code then it could lead to a claim denial, delayed payment, or even legal issues.

- Staying updated on coding standards: Medical coding constantly changes so coders need to stay up-to-date on changes to codes and guidelines.

Without medical coders, healthcare providers are unable to accurately document the services they've provided. That’s why they need medical coders that handle the entire process of diagnosis and treatment and make their billing process more efficient.

Role of Coders

Differences Between Medical Billing and Medical Coding

After understanding what medical billing and coding services are now let’s quickly go through the ways that actually make them different from each other.

The Focus

- Medical Billing: The focus of medical billing is on the financial side of healthcare. Billers work with insurance companies and patients so that healthcare providers get paid for their services.

- Medical Coding: The focus of medical coding is on accurately translating the services provided during a patient’s visit into standardized codes. Coders are more concerned with the medical information than the financial aspects.

The Process

- Medical Billing: Billers generate bills, submit claims to insurance, and follow up to ensure payments are made.

- Medical Coding: Coders review patient records, assign the correct codes, and make sure that all services are accurately documented.

The Skills Required

- Medical Billing: Billers need strong organizational skills and an understanding of insurance procedures. They also need to be good at communication as they mostly interact with insurance companies and patients.

- Medical Coding: Coders need to have great knowledge of medical terminology, anatomy, and the different types of coding systems. They also need to be detail-oriented as one mistake in coding can lead to a rejection of claims.

The Tools They Use

- Medical Billing: Billers use billing software to generate and track claims as well as to communicate with insurance companies. These tools help them manage the entire billing cycle.

- Medical Coding: Coders rely heavily on coding manuals, electronic health records (EHR), and coding software to assign the correct codes to patient treatments.

How Billing and Coding Work Together

Medical billing and coding services aren’t independent processes as they both rely on each other to function properly. But why? Let’s get the answer.

- Medical Coding: The process starts with the medical coder. They review the patient’s records and assign the appropriate codes to all diagnoses, procedures, and treatments.

- Medical Billing: Once the coding is complete then the medical biller takes over. They use the codes to generate a detailed bill and submit the claim to the patient’s insurance provider.

- Claim Follow-Up: If the insurance company has any questions or issues with the claim, the biller works with the provider to resolve the problem. The coder can be called upon if there’s a need for clarification about the codes used.

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In other words, without the coders, there would be no codes for billers to use when creating claims and without billers, the coders’ work would never get paid for. Both roles are important to the overall financial health of healthcare organizations.

Choose the Right Medical Billing Company

Healthcare providers cannot get reimbursed for the services they have provided without billing and coding. That’s why they need a reliable billing partner who manages all the tasks of billing and coding. Here’s the best choice to outsource medical billing services is QuickPay Solution which provides both medical billing and coding services. You never need to hire them separately. We help you prevent claim denials, reduce the risk of fraud, and ensure that your practice is paid fairly for its services. Choose the best medical billing company and improve your overall revenue cycle management.