Although there are similarities between the two, medical coding and billing are in fact two separate processes. Contrary to common belief by people, they are not one and the same. In both the processes, professionals happen to work in health care setting, gather health information from the patients, and confer with physicians and insurance companies. The similarity ends here.
Fundamental Functions of Medical Coders
Medical coders are entrusted with the determination of the procedures that have been performed by the physician, surgeon, or other member of the health care team. They then assign the diagnosis code or proper procedure code for the corresponding services provided by the medical professionals to the patient.
Medical coders make use of Current Procedural Terminology (CPT) for allocating codes related to procedures received by patients; they refer to International Classification of Diseases (ICD) for choosing the diagnosis code for labeling the concerned physician’s diagnosis about patient’s condition. Coders are expected to assign perfect codes as these will be used as base by insurance providers toward patients’ insurance claims.
What do the Medical Billers do?
Medical billing involves entering codes into specific software and then processing insurance claims. Medical billers use special billing software that lets them enter the codes that are assigned by coder as well as other relevant information- facilitating sending the claim to insurance company for payment.
Entrusted with the process of dealing with insurance providers, medical billers are expected to have complete knowledge of the claims process and all requirements that need to be submitted for processing claims. The responsibility of handing proper insurance claims lies with them too. In this connection, they must ensure that correct billing format is followed, all fields have been answered properly, and all supporting documents are included in the file.
Distinct Processes in Medical Coding
It is the medical coder’s responsibility to decipher documentation of patients’ interaction with care providers such as physicians, surgeons, or nurses – they determine appropriate diagnosis and procedure codes for reflecting the services provided.
Exclusive Tasks in Medical Billing
Medical biller takes the assigned codes along with necessary insurance data, inputs them into the specific billing software, and submits claim to the payer (which is mostly an insurance company) for payment. Moreover, billers need to follow up on the claim as and when required.
To put it shortly, medical coders and billers are entrusted with the task of collecting information, coding claims, and arranging payment for physicians in timely manner. Both these roles are crucial for practice cash flow.