Most of the time, Medical Biller and Medical Coder are the two roles of the very same professional due to integrated and overlapping nature of these skill sets. However, they are different disciplines with their own responsibilities and specialties.
Medical Coding vs Medical Billing
Mostly, Medical Billers are also Medical Coders because both roles involve the review of medical documentation its standardized into ICD and CPT codes into to submit a healthcare insurance claim in HIPAA complaint format to insurance clearing house or insurance for payment.
While, Medical Billing is related to providing accurate, timely reimbursement based on the ICD and CPT codes used, Medical Coding is more focused on documenting a health insurance claim with maximum possible quality in term of completeness and correctness, leaving the reimbursement and follow-up related function to the Medical Billers.
Medical Coding involves listening to recordings made by physicians (providers) or other health care professionals at provider office and document medical insurance claim(s) on the bases of that documentation. This documentation comes in the form of patient charts, visit summaries, discharge reports, patient surgical reports or diagnostic test studies. Medical Coders must have expertise in understanding and documenting medical terminology with and excellent knowledge of ICD and CPT codings.
Medical Billing involves working with patient health insurance claims. Since many hospitals and physicians' offices outsource billing and insurance claims to third parties, medical billers can find a reliable workload. They manage patient records, file insurance claims, prepare insurance forms and send bills to patients. Medical billers need to communicate with both insurance companies and physicians to ensure they properly code medical services. They need to understand medical coding so that insurance claims are processed accurately.
Medical Coding and Billing Process SimilaritiesBoth Medical Coding and Medical Billing require specific knowledge in the medical field. While Medical Billers and Coders do not have to know how to treat patients, they have to possess a specific set of medical knowledge--medical terminology for coding and billings of health insurance claims.
Individuals in both Medical Coding and Medical Billing can work in traditional health care settings in hospitals or physicians' offices or they can work for third parties or even for themselves from the comfort of home.
Medical Biller vs Coder DifferencesAlthough both Medical Coders and medical billers provide services for hospitals and physicians' offices, their purpose is distinctly different. Medical Coders work on the medical, patient-care side of health care, helping develop reports that physicians can assess and learn from.
Medical Billing ensures that the patient and health insurance company are properly billed for all procedures. Approved claims are reimbursed, while rejected claims are researched and amended. Thus Medical Billing is a part of the business side of health care.