What Is Medical Billing and Coding?

Every healthcare professional plays an important role in the lives of patients and practitioners alike, and medical billing and coding professionals are no exception.

Medical billers and coders can directly impact the success of their employer, too—patients who are highly satisfied with their medical provider’s billing process are more than five times as likely to recommend the hospital to a friend than those who are less than satisfied1.

Here, we’ll discuss what medical billing and coding is by exploring definitions of each, why they're important and what they involve.

WHAT IS MEDICAL BILLING?

Medical billing involves reviewing medical records and identifying the diagnoses and procedures the patient had. This information is used to submit claims to insurance providers, government programs and/or patients directly in order to receive reimbursement2.

WHAT IS MEDICAL CODING?

Medical coding is a key component of medical practices and healthcare facilities. Certified medical coders must understand anatomy and physiology, the disease process and clinical procedures so they can apply the correct codes to health records and claims2.

IS MEDICAL BILLING DIFFERENT FROM MEDICAL CODING?

Medical billing and medical coding are not the same. Medical coding, which is generally the first part of the medical billing and coding process, involves applying the correct codes to health records and claims. Medical billing, which is usually the second part of the process, involves submitting claims to those covering the cost of the service or treatment, such as patients and insurance agencies.


WHY IS MEDICAL BILLING AND CODING IMPORTANT?

Medical billing and coding is important to healthcare facilities because proper medical billing and coding procedures result in an improved bottom line.

Medical billing and coding is important to patients because proper medical and coding procedures prevent patients from being charged more than they should be. For example, an incorrectly entered code could indicate that a patient received a much more expensive treatment than they actually did.

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What does a medical biller and coder do?

Medical billing and coding professionals’ duties vary depending on whether they’re performing billing- or coding-related tasks.

Medical Coding

  • Working with healthcare professionals to correctly identify the services and treatments a patient has received
  • Ensuring that medical records correctly reflect their patients' care
  • Staying up-to-date with new coding regulations and standards

Medical Billing

  • Submitting claims to insurance companies
  • Ensuring that the responsible party pays for claims
  • Managing payments and invoices

Medical billing and coding professionals are also responsible for investigating rejected or denied claims. There’s an important difference between a rejected claim and a denied one. A rejected claim is found to have one or more errors before being processed and can thus be corrected and resubmitted.

A denied claim, on the other hand, is a claim which has already been processed but has been denied by the paying party—for example, an insurance company may deny a claim because it violates their agreement with the patient.

In both cases, a medical biller and coder must examine the claim in question and work to resolve the issue as quickly as possible. They can accomplish this by performing a thorough audit of the claim in question, and correcting any mistakes or discrepancies that they find.


HOW CAN I BECOME A MEDICAL BILLER AND CODER?

To become a medical biller and coder, start with a medical billing and coding undergraduate program from an accredited school. Upon completion of your program, consider obtaining a certification.

The three most common nationally recognized medical billing and coding certifications are:

  • Certified Coding Specialist (CCS), offered by the American Health Information Management Association (AHIMA)
  • Certified Coding Associate (CCA), offered by AHIMA
  • Certified Professional Coder (CPC), offered by AAPC

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