Medical Coding And Billing Not The Same Thing

by  Find-A-Code™
Sep 3rd, 2022

Medical coding and billing are two careers that relate to translating patient medical data into bills that are ultimately submitted to insurance companies for payment. The two careers overlap to a certain degree, but they are distinctly separate entities. Simply put, medical coding and billing are not the same thing.

Medical coders and billers work together to ensure healthcare providers get paid. In some cases, they work together in the same office. In other cases, coders and billers never directly interact. Any interactions they do have are conducted electronically.

So what do these two careers involve? Keep reading to find out. If you are interested in either one, check with your local community college to see if they have a certification program. Training and certification will go a long way toward helping you build the kind of career you want.

What Medical Coders Do

Whenever a patient visits with a healthcare provider, the visit needs to be documented. Much of the data included in that documentation is used for billing purposes. However, it would be impractical for a healthcare provider to submit the required data to insurance companies in long-hand format. This is where medical coders come in.

Medical coders translate the data recorded by healthcare providers into alphanumeric codes. A good example would be that of a patient visiting with his primary care provider after experiencing symptoms he believes might be COVID related.

The consultation itself has a code. So does the doctor's diagnosis and any prescribed treatments or procedures. If the doctor orders tests, those tests will also have codes assigned to them. It is the coders task to go through all the information from the visit and assign the proper codes. Those codes are utilized by medical billers.

What Medical Billers Do

Also known as billing specialists, medical billers delve into patient records after the fact. They look at the codes generated by a particular visit, then translate those codes into billable services. The codes are utilized to prepare bills for submission to insurance companies.

Going back to the previous example, a medical biller might be looking at half-a-dozen different codes generated as a result of the patient's visit. Even if the doctor has determined the patient is not suffering from COVID, there will be some sort of code explaining his diagnosis. It is not up to the medical biller to decide whether a diagnosis is correct. Their task is to simply turn codes into bills.

When Bills Are Submitted

Completed bills are submitted to insurance companies for review and payment. Bills returned due to errors or insufficient data are pretty common. They represent one of the reasons medical coders and billers need to work together. Let's say our fictional patient's insurance company believes his visit was incorrectly coded and sends it back to the provider. Then what?

The bill goes back to the billing specialist for review. They contact the coder and asks that the visit be recoded. Together, the two of them figure out why the insurance company believes an error was made and then work to correct it. Recoding generates another bill which is then submitted for payment.

As a side note, medical billers are also tasked with sorting out who pays what. In most cases, the insurance company pays the lion's share while the patient is responsible for their co-pay. Billers need to keep track of it all to ensure providers get paid the right amount.

Although medical coding and billing do sometimes overlap, they are separate entities. Both offer plenty of opportunities for long and rewarding careers.