What is medical billing and coding?
Actually, the term “medical billing and coding” does not refer to a single job, but rather to two closely related fields in the field of healthcare administration (such professionals are often referred to as “healthcare administrative technicians”). While it’s true that many medial billers are also medical coders this is not always the case, nor does it necessarily need to be so.
So let’s start by discussing medical billing, since it’s the most obvious.
In a country like the United States (which does not have socialized healthcare), most healthcare services have a direct cost “either to the patient, or to his or her insurance company (whether a private insurance company or a federal program), and often, a combination of the two.”
Medical professionals may provide the healthcare services to the patient, but they are not directly responsible for obtaining payment for the services they provide. Image just how much your doctor would get done on a daily basis if she or he also had to do the billing and chase down payments that were in default?
You think you have a hard time getting a timely appointment now?
No, it is the medical biller’s job to compile the necessary supportive paperwork and bill the appropriate people and institutions for the services rendered.
Insurance companies need precise documentation of the services and procedures provided by the medical professional, as well as specifics of the patient’s medical record, including the nature of the medical condition treated; whether it is pre-existing, or spontaneous. The medical biller will provide this information to them, and in turn the insurance company will the pay the healthcare provider.
The medical biller’s work starts even before the patient sees the medical provider “obtaining from the patient proof and the specifics of insurance coverage, or the proof of means to pay the bill otherwise.”
Medical billers may also work for insurance companies themselves, where a large part of their work is following up with insured individuals to ensure they pay their share of the medical costs (also known as the deductible). If there are disputes arising over which party pays what, the medical biller will often intercede to address these issues as well.
So what is medical coding?
It is also involved with similar medical administrative work, but it has a more specific focus. In order for the information involved in any medical transaction to be transferred efficiently between the relevant parties; the medical health care provider, the patient, and the insurance company, a very precise means of documentation was devised. In short, numerous alpha numeric codes are used to designate diagnoses, medical procedures, medications (also known as pharmaceutical codes), and even various areas on the body (also called “topographical codes”).
The medical coder is an expert in these alpha numeric codes, and using the information in a patient’s file (which can include the doctor’s comments and recommendations, diagnosis of a condition or conditions, documentation of a treatment and procedures, and dispensing of any medication) converts this into a report featuring the appropriate codes.
The codes can then be transferred onto a bill, and an accurate cost assessment can be made. Since the codes are standard across the medical industry, this allows for quick and efficient processing of insurance claims as well as cost assessments.
Medical billers therefore, are also often medical coders, or at least somewhat familiar with the coding element of the business. However, if they are not, they will work hand in hand with the medical coder to ensure proper payment is made for any healthcare procedure.
In conclusion, medical billing and medical coding are often mistakenly combined into medical billing and coding, despite the fact that these are two distinct but closely related skill sets, not necessarily performed by the same person.ocat