What is Medical Billing and Coding?

What is Medical Billing and Coding? – Overview

Medical billing and coding professionals are essential in healthcare settings. They are key to ensuring accurate billing and coding for healthcare services, which is crucial for healthcare providers’ financial health.

This field is for those who wish to join the healthcare community.

The Difference between Medical Billing and Medical Coding

Most people talk about medical billing and medical coding together. However, these are two very different professions.

Due to the complexity and specificity of the work, medical billing and coding positions typically require postsecondary education or certification.

Medical billing professionals submit claims to insurance companies and types of payers. This needs to be done in a timely and accurate manner.

It ensures that the healthcare provider gets paid on time for their services.

Due to their technical and regulatory nature, medical billing and coding positions commonly require specialized education, training, or certification.

Coding professionals play a critical role in healthcare providers’ revenue cycle management by accurately coding services for billing and reimbursement.

Individuals with in-depth knowledge and the ability to handle additional responsibilities are ideal for working as medical coding professionals.

Medical coding professionals review clinical documentation from healthcare providers and assign appropriate codes for billing and reimbursement purposes.

It’s common for smaller healthcare facilities to employ individuals who handle both medical billing and coding, while larger organizations may have separate specialists for each function.

Everything About Medical Billing

Medical billing professionals are responsible for submitting claims. These claims need accurate and relevant codes entered by the medical coder.

This is important to communicate with insurance companies and other payers. Billing is a time-sensitive task and is tied to reimbursement for medical services.

A medical biller takes up once the medical coder has finished their work. Apart from submitting claims, medical billers also follow up on unpaid invoices.

They are responsible for creating patient invoices, developing payment plans, etc. A medical billing professional ensures that a healthcare facility is reimbursed for the complete invoice amount.

Medical billing also requires an immense eye for detail. Medical billers must check for errors to ensure timely reimbursement, necessitating a foundational understanding of medical coding practices and systems.

Medical billers are responsible for billing processes and follow-ups to ensure healthcare providers are reimbursed for services provided. Usually, a day in the life of a medical billing professional involves:

Using diagnosis and treatment codes from medical coders to create and submit compensation claims
Reviewing claims and codes to ensure accuracy of the level of healthcare provided by the hospital/clinic
Communicating with healthcare providers, medical coders, and insurance companies to iron out any inaccuracies or discrepancies.
Working with patients to recover unpaid invoice amounts by insurance companies or other payers
Communicating with healthcare providers and insurance companies to get pre-authorization for procedures and treatments as required

Everything about Medical Coding

Medical coding professionals are required to work on time-sensitive tasks. Their work directly impacts the healthcare provider’s cash flow.

This means that healthcare organizations depend on medical coders to ensure continued reimbursement. Although medical coders primarily focus on coding clinical documentation for billing purposes, some are also responsible for managing medical supplies and stocking, among other tasks.

Accuracy and attention to detail are critical skills for medical coders as they translate medical records into standardized codes used for billing and reporting. This is essential to pick relevant information from documents and convert it into correct medical codes.

Medical coders are integral to the functions of healthcare providers. Usually, a medical coder’s typical day involves:

Reviewing medical documents and translating notes into different codes
Communicating with doctors, insurance companies and other payers
Using digital coding software tools and patient record platforms

Employment opportunities for medical billing and coding professionals

Certified Medical billing and coding professionals can be employed by healthcare facilities, insurance companies, and billing companies and may also work remotely. They can work with clinics, standalone doctors’ offices, healthcare systems and hospitals.

They can also find work at nursing homes, long-term care facilities, rehabilitation centers, and even in the prison system.

The average salary for medical billing and medical coding professionals

Medical billing and medical coding professionals are classified as health information specialists.

The salary range for these professionals varies significantly. Due to the technical nature of the work, some medical coders may earn more than medical billing professionals, but salaries can vary widely and overlap depending on specific job roles, experience, and location.

This is because the medical coders’ task is significantly more technical and requires additional education and training.

For the most accurate and current salary figures for health information technicians, including medical billers and coders, refer directly to the US Bureau of Labor Statistics (BLS) website or reputable salary survey data. See more at Medical Billing and Coding Salary.

The salary will differ according to location, type of healthcare setting and certification.

Conclusion

Medical billing and medical coding professionals are in high demand thanks to the digitalization of the healthcare industry.

You can find employment in numerous workplaces as a certified medical coder or biller.

Please check our previous article to learn more about certifications and other requirements to become medical billers and coders.

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What is Medical Billing and Coding?