Introduction

What is Medical Billing and Medical Coding?

The healthcare industry depends on skilled, qualified medical insurance billers and coders to accurately record, register and track patient accounts. Even though “medical billing and coding” is often referred to as though it’s a single career, in reality medical billing and medical coding are two separate functions and two unique jobs. There’s a very specific task flow that includes both medical billers and medical coders.

Medical Coding

  • Medical coders update patient files using a universally recognized coding system (ICD-10) to ensure compliance with federal regulations and insurance requirements.
  • They first decipher a doctor, nurse, surgeon, technician or nurse practitioner’s notes and determine which procedure and diagnosis code best reflect the treatment and services provided by the medical team.
  • Coders often must confer with the physician or medical team to clarify diagnosis and procedures to make sure they are interpreting the patient’s chart correctly.
  • Medical coders have much less interaction with insurance companies and spend most of their time assessing and coding data.
  • Every duty performed in a medical office has a particular code assigned to it and it needs to be coded properly for billing and reimbursement purposes.

Medical Billing

  • Medical billing is the process of submitting and following up on claims with health insurance companies in order to receive payment for services rendered by a healthcare provider.
  • Medical billing translates a healthcare service into a billing claim.
  • The responsibility of the medical biller in a healthcare facility is to follow the claim to ensure the practice receives reimbursement for the work the providers perform.
  • A knowledgeable biller can optimize revenue performance for the practice.

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