What Is Medical Billing?
Medical billing is the review of medical records to identify, code and bill for diagnoses, procedures, medications or equipment associated with a patient’s care. Once a medical billing professional identifies this information, they submit claims to payers or patients to receive reimbursement for services rendered. Read What is Medical Billing?” to learn more.
What Is Medical Coding?
Medical coding is the process of assigning codes to medical diagnoses, procedures and equipment using the International Classification of Diseases system to accurately track patient data. Medical coders must understand anatomy and physiology, the disease process and clinical procedures so they can apply the correct codes to health records. Read What is Medical Coding? to learn more.
What Do Medical Billers and Coders Do?
Medical billing and medical coding are two distinct but interconnected parts of the healthcare system. Medical coding, which is typically the first part of the process, involves applying the correct codes to health records and claims. Medical billing involves submitting claims to payers.
While medical billers and medical coders are two distinct careers with different skillsets, they may share similar duties or professional qualifications. Their work is essential to maintaining the financial health and successful operation of any healthcare facility.
What Does a Medical Coder Do?
On a typical day, a medical coder may perform these duties:
- Review medical documentation and translate notes into ICD or Healthcare Common Procedure Coding System (HCPCS) codes
- Communicate with medical providers and insurance companies or other payers
- Correspond with healthcare providers to obtain or confirm details that will enable them to “code to the highest degree of specificity,” thereby reducing claim denials
- Use digital tools such as coding software and patient record platforms
What Does a Medical Biller Do?
Medical billers take over where the coders have left off, ensuring providers and facilities receive correct payment for their services. On a typical day, they may:
- Use diagnosis and treatment codes provided by medical coders to create and submit new reimbursement claims
- Review codes and claims to ensure they are accurate and represent the level of care provided
- Communicate with providers, coders and insurance companies to work out any discrepancies or disagreements
- Work with patients to get reimbursement for remaining costs not covered by insurance companies or other payers
- Communicate with healthcare providers, healthcare facilities and insurance companies to get pre-authorization for treatments or procedures as needed
These medical billing and coding examples will show you what medical billers’ and coders’ day-to-day tasks look like.