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It is a common misconception amongst most people that medical coding and medical billing are similar job functions, while in reality they are two widely different tasks. For a layman these two functions may seem to be one and the same, but there are some stark differences between the two. Professionals in both fields use similar skills to achieve similar results, but the methods they use, and the way they pursue their goals, are completely different.
These two skill sets overlap because both professions involve the translation of medical documentation into standardized codes so as to communicate important medical information between respective parties. While medical billers focus on providing accurate and timely reimbursement based on the codes used, a medical coder's role is to provide the most complete picture possible of a medical encounter, leaving the money-related aspects to the billers.
Before we have a discussion about medical billing vs. coding, one needs to understand clear-cut definitions for both medical billing and medical coding.
Medical billing involves processing and submitting patients' medical claims to insurance companies and government agencies for services rendered to the patient.
Medical coding focuses more specifically on patient medical records. Accurate coding helps in preventing misleading notes or diagnoses.
Medical billers primarily work with patients and insurance companies on claims submissions. Billers often perform more customer-oriented tasks than medical coders. Medical coders, on the other hand, generally work with healthcare professionals to accurately categorize the services and products provided to the patients. The following table depicts major differences between medical billing and coding:
Mainly involves entering data with the help of proprietary billing software
Involves communicating with physicians, nurses, and other healthcare professionals to categorize the services a patient has received
Submitting insurance claims to insurance companies
Applying CPT, HCPCS, and ICD-10 CM standardized codes to patient records to accurately reflect the services received
Following-up with patients, healthcare professionals, and insurance providers to make sure the claims are paid for
Entering data through Electronic Health Record (EHR) and Electronic Medical Record (EMR) software used in hospitals and physicians' offices
Managing account payments and invoices
Examining operative reports used during surgery to apply procedure codes
Investigating denied or rejected claims
Performing medical chart audits when a claim is denied
Ensuring the physicians and patients receive reimbursements from insurers
Staying updated with the latest revisions of coding standards and federal regulations
Verifying the accuracy of standard healthcare codes used by medical coders to classify services and products
Examining patient charts and histories to ensure coding accurately reflects a patient's medical care
Medical coding is a bit like translation. Coders take medical reports from doctors, which may include a patient's condition, the doctor's diagnosis, a prescription, and whatever procedures the doctor or healthcare provider performed on the patient, and turn that into a set of codes, which make up a crucial part of the medical claim. Some of the key benefits of medical coding include:
Most practices are aware of how medical billing services and revenue cycle management can reduce costs and increase collections, thanks to electronic eligibility verification and other benefits. Some of the key advantages of medical billing include:
Medical billing and coding can be an excellent starting point for those who wish to explore alternative clinical or health administration options. According to the US Bureau of Labor Statistics (BLS), the field of medical billing and coding is expected to increase by 25% between 2015 and 2020.
Medical coding is a specialized profession within the wider field of healthcare administration. According to the American Academy of Professional Coders (AAPC) there are over 110,000 certified medical coders who carry credentials from this organization. Medical coding is usually used in the healthcare industry by healthcare service providers. Whether in an office or in a specialized company, the demand for people having personal skills and knowledge about medical coding will always be there. Employment opportunities in the field of medical coding are expected to grow by almost 14% in the coming few years.
Rapid changes in the industry have made it difficult for medical billers to keep up and gain the tools they need to succeed in the modern healthcare place. The key in any industry is to make a profitable margin and companies that fall short, inevitably fail. As we move from a volume-based medical world into a value-based one, medical billing companies of the future must have industry-specific knowledge, solid client retention, practice management processes and the ability to understand how a practice finds margin per case. By 2020, more than $46 billion will be spent on national healthcare in the USA alone, with a vast majority of the bills being submitted in code. As a result, there will be increased demand for medical billers who have a solid foundation in CPT code terminology, HCPCS, and ICD-10.
Flatworld Solutions has been providing top-quality medical coding and billing services for over a decade now to clients around the world. Our team of experienced medical billers and CPT certified coders has been trained to handle any volume of work and deliver results within a quick turnaround time. By availing our cost-effective services we assure you cleaner claims, fewer denials, and enhanced revenue.
If you have any kind of medical coding or medical billing requirement, feel free to get in touch with us and we will be more than happy to help you out.