On the surface, medical billing and medical coding can look quite similar to the untrained eye. After all, they both involves processing a patient’s information and the provider’s documentation, and they are both essential to making sure that the medical facilities receive proper reimbursement. Past this, however, the jobs vary greatly, so it is essential to understand exactly what areas each position covers.
As a general rule, medical coders specialize in synthesizing all the various provider notes and chart readings in order to create an overall picture of the patient. In other words, coders are the ones who receive the documentation straight from the provider and who must then find the proper code(s) that correspond to the patient’s diagnosis. This means that coders must have an extensive knowledge of both medical terminology and the coding formats that they employ (including ICD-10 codes, HCPCS codes, and CPT codes). Though coders do not necessarily have to have all these codes committed to memory, they should know exactly how to look up a diagnosis quickly and accurately in order to keep their practices running smoothly.
Medical billing, on the other hand, is the next step in the process. Once the coder has received the provider’s documentation and translated it into the proper code, he or she will send this coding designation on to the biller. From there, the biller will use the codes provided to send the patient an accurate pay statement and file for the proper reimbursement for the facility. Though billers do not need to understand the intricacies of coding to the same extent as the coders themselves, they will need to know the codes well enough to match them with the appropriate reimbursement levels, in addition to knowing how to navigate the complex world of insurance claims.
There are, however, instances in which a single person may operate as both a medical coder and biller. For example, many smaller facilities do not have resources or space to hire separate coding and billing teams. Instead, they often employ just a few people who are trained in both fields and who can take a patient’s info from a sheet of provider documentation all the way to a completed claim. Though this means quite a bit more work for the employees, it often comes with a sizable salary boost.
All in all, both medical coding and medical billing are an essential part of the healthcare industry. Though both require varying degrees of knowledge and training, the two sides must work in tandem in order to facilitate good practice workflow. If you are interested in becoming certified as a medical coder or biller, check out MMI’s registered medical coder (RMC) and registered medical biller (RMB) certifications.