Medical Coding vs Medical Billing: What’s the Difference?

Medical Coding vs Medical Billing: What’s the Difference?
  • Opening Intro -

    Are you contemplating a career as a medical biller or coder? If so, you're looking in the right direction.

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The demand for jobs in this field is expected to grow 13% by the year 2026.

If you’re thinking about a career in a healthcare facility, you may be undecided between becoming a medical biller or a coder. If you’re stuck between the two, we’ll explain more about the contrasts of each profession. To understand medical coding vs medical billing, just keep reading.

Medical Coding Basics

Medical coding translates healthcare diagnosis, medical services, procedures, and equipment. It’s a simplified system that transforms important medical information into codes to document medical records and ensure accurate medical billing.

Medical coders make sure that the codes are applied correctly during the process of billing.

The process includes taking the information from the documents, assigning the appropriate codes, and creating a claim for insurance providers.

  • Medical codes explain the following information:
  • Patient diagnosis
  • Treatments, supplies, and services provided
  • Medical necessity for treatment
  • Unusual situations or health conditions that affected treatment

Medical Coding 101: What’s Its Purpose?

The documentation of services performed determines healthcare revenue. A patient’s diagnosis, treatment, and test results must be recorded.

The documents ensure that the insurance company reimburses medical providers for services rendered.

For instance, if a patient receives a colonoscopy, the proper coding is needed to make sure it’s billed to the insurance company correctly and pays at the proper rate.

It also offers quality care for future visits. A patient’s medical information follows them through various treatments that they undergo for their health. Understanding a patient’s medical history is essential to providing the appropriate care for their condition.

Plus, coding helps to document any complaints regarding the services they received.

This system is essential because there are millions of doctor’s visits, hospitalizations, and procedures performed each year in the United States. Because of that, every service and treatment must be easy to comprehend.

Medical billing 101: What is It?

Medical billing consists of submitting claims and following up on them with the health insurance company. This process ensures that payment is received for services rendered by the medical professional. The medical biller’s job is to keep tabs on the claim until it pays out.

Medical Coding vs Medical Billing

Although medical billing and medical coding work hand-in-hand, they are not the same. A medical coder reviews clinical statements and assigns codes using the CPT, ICD-10-CM, and the HCPCS level II systems.

On the contrary, medical biller processes and follows up on claims to ensure reimbursement. In most healthcare facilities, medical coders and billers are the same people. However, they might also be different individuals who work together to ensure invoices are paid correctly.

Becoming a Medical Biller and Coder

The wonderful thing about coding and medical billing training is that it only takes about a year to complete. That means you can start a rewarding career in a short amount of time. Most training courses for medical billing and coding include, but are not limited to:

  • Anatomy and physiology
  • Digital health records
  • Diagnostic coding
  • Procedural coding
  • Professional development
  • Physician billing and insurance billing
  • Medical terminology

One of the perks of becoming a medical biller and coder is the opportunity to work from home. Although many of them work in clinics, hospitals, or doctor’s offices, some have the option to work remotely.

The job requires a computer, billing and coding software, a good internet connection, and a phone. If you have these tools, you don’t have to work from a medical facility.

Medical Billing and Coding Fundamentals

If you choose to work in a medical office, there are certain skills you need. Not to mention, some rules must be followed.

Here’s what’s required in order to succeed in a medical office environment:

  • Following HIPAA Guidelines

    The Health Insurance Portability and Accountability Act is essential in the medical field. HIPAA provides strict guidelines that help to protect the medical information of all patients.

    A breach in policy can cause legal consequences, termination, or fines. As a medical coder and biller, it is vital to adhere to the regulations set by HIPAA.

    For example, as a medical professional, you are not allowed to disclose any information regarding a person’s health condition. You must also be careful when discarding documentation and sending it to sources outside of the office.

    Most likely, the medical facility will have protected billing and coding software to make sure there’s extra security.

  • Communication with Patients

    As a medical biller, all of your duties won’t include computer work. You’ll have to communicate with patients and the insurance company. Therefore, it’s important to know how to communicate information in a simple way.

    As a medical biller, knowledge of basic medical terms and insurance policies ensure that communication is comprehendible and free of misunderstanding.

  • Phone Calls and Emails

    Another aspect of your position will include sending numerous emails. You’ll also have to make lots of phone calls. It’s important to speak on the phone in a professional manner, as well as have proper email etiquette.

other valuable tips:

Are You Ready to Start a Rewarding Career?

Now that you know the difference between medical coding vs medical billing, which one is your choice? No matter which profession you select, both offer a rewarding career. Plus, you can always choose to do both!

Did you learn anything from this article? If so, take a look at the rest of our blog. We cover a variety of topics regarding education and careers.

If you’re looking to advance your future, our website is for you. Keep exploring to learn more.

Image Credit: medical coding vs medical billing by twenty20.com

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