What is the Difference between Medical Billing and Medical Coding?
With our fantastic reputation among online medical billing and coding schools, Blackstone Career Institute offers students the ability to obtain their medical billing and coding certification to enter today’s competitive health information industry, prepared!
As our Blackstone students know, medical billing and coding are referred to as one career in today’s health information industry. However, billing and coding really are two distinct careers. Here is a brief description of the tasks and functions associated with each job:
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The medical coder deciphers the documentation of a patient’s interaction with a healthcare provider (physician, surgeon, nursing staff, and so on) and determines the appropriate procedure (CPT) and diagnosis code(s) to reflect the services provided.
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The medical biller uses the assigned codes and any required insurance information, enters them into the billing software and then submits the claim to the payer (often an insurance company). A medical biller also follows up on the claim as necessary.
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Both medical billers and medical coders are responsible for a variety of tasks, and they’re in constant interaction with a variety of people (you can read about the various stakeholders in Part V). Consider these examples:
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Medical billers are responsible for billing insurance companies and patients and therefore have daily interaction with both patients and insurance companies to ensure that claims are paid in a reasonable time.
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To ensure coding accuracy, medical coders often find themselves querying physicians regarding any questions they may have about the procedures that were performed during the patient encounter and educating other office staff on gathering required information.
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Medical billers (and sometimes medical coders) have the responsibility to explain charges to patients, particularly when patients need help understanding their payment obligations, such as co-insurance and co-payments.
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When submitting claims to the insurance company, medical billers are responsible for verifying the correct billing format, assigning the proper modifier(s), and submitting all required documentation with each claim.