Running a healthcare system without being able to differentiate between similar terminologies can be overwhelming and may even result in errors that risk the entirety of a company. Are you confused about which of these two occupations would be the best for you? We figured out a comprehensive way to talk about the differences between medical coding vs medical billing so you do not have to wonder anymore! Read on ahead to find out what makes these two frequently used terminologies in the healthcare system different from one another.
Medical coding vs medical billing
Medical billing and medical coding are the best ways to ensure proper patient billing and insurance management. These jobs usually go hand in hand to improve the healthcare facility’s working standards and generate revenue. Medical billing vs medical coding simultaneously works towards receiving timely reimbursements for a hospital, doctor’s office, clinic, or any healthcare setting.
The responsibilities of medical coding and medical billing professionals vary from one slightly. While medical coders are required to organize the care provided to the patients according to codes, medical billers file insurance claims to receive reimbursements in the manner provided by the medical coders.
Medical coding
Medical coding is the name given to the process of compiling information on a diagnosis, treatment, or service received by the patient with the help of assigned codes. This job is restricted to technicians who excel in medical coding and are commonly called medical coding specialists. By coding past and current records of the patient’s walk-in or appointment-based visit to the hospital facility, the services provided are then easily separated and added to an invoice. Using codes for a different task or service provided classifies recorded data accordingly. This data can later be easily referred to for insurance credits and reimbursements.
Medical coding specialists are only allowed to use codes from the International Classification of Diseases and the Current Procedural Terminology or CPT. The 10th revision of the CPT codes list (ICD-10) assigns a five-digit billing code to the provided services, which are the same globally for private and public systems across all states. The American Medical Association is responsible for publishing CPT-10 codes twice per year and categorizes them as follows.
- Category I: codes related to primary care and services provided, such as care provided to treat a myocardial infarction
- Category II: for recording Category, I code for performance measurement
- Category III: restricted to assigning codes to new and emerging medical treatments, such as the Pfizer vaccine for COVID-19
These CPT codes make a person’s medical records easily accessible to the hospital staff at all times. These records include the type of service offered, such as walk-in or appointment-based, the diagnosis and treatment received by the patient, and the psychological or lab test results, if any. This further reduces the administrative burden by helping them in determining the coverage costs and follow up with the appropriate reimbursement plan.
Medical billing
The process of generating medical claims to later submit them to insurance companies for reimbursement purposes is known as medical billing. This way, a healthcare claim for the medical services utilized by the client or patient is translated into a billing claim. Efficient medical billing and coding services not only ensure reimbursements but also optimizes the revenue performance of your healthcare practice.
Medical billers work to ensure that the medical records of all patients are complete and updated with every visit. This allows detailed information about the services provided to the patient easily accessible to the insurance companies so the cost can be reimbursed without delay. Certified billing specialists handle all the disputes, and billing documentation, and make changes where potential risks or errors are detected. the process of medical billing consists of two phases.
Front-end medical billing
This occurs when a walk-in patient enters the hospital to avail of their services. This sort of medical billing may also be applied to patients who make appointments beforehand. It involves the patient providing the administrative staff with their complete insurance details so they can be verified with their respective insurance company during the limited course of time.
Back-end medical billing
This form of medical billing requires medical billers and medical coders to work together to formulate documents that present the biller with the structure for the insurance.
After clearance of the insurance claims, the medical billers work on issuing statements to the patients about their remaining fees.
The difference between medical billing and coding
While both these professions require qualified and experienced individuals, they differ in other aspects. The following contrasts between medical billing vs medical coding may assist you in deciding which profession suits your skillset and future goals.
Certifications
When it comes to education, medical billers, and coders have multiple options that will qualify them for their job. They could either choose a relevant college program or any of the vast variety of certificates from private institutions. These certifications must prove that the applicant is thorough in the field they are willing to apply to. A higher number of certifications is likely to increase the likelihood of the applicant getting a better job with a better salary.
The American Academy of Professional Coders or AAPC offers the following certifications for medical coders:
- CIC or Certified Inpatient Coder
- COC or Certified Outpatient Coder
- CRC or Certified Risk Adjustment Coder
- CPC or Certified Professional Coder
The qualifications offered by AAPC for medical billers include:
- CBCS or Certified Billing and Coding Specialist
- CPB or Certified Professional Biller
Education and training
A high school diploma or any other college certification would suffice for medical billers and medical coders. Medical billers may even be considered qualified with a full or associate degree in finance or medical billing courses. Medical coders, on the other hand, require more qualifications than medical billers. They need to specialize in coding to know and stay updated with medical terminology.
Job duties and skills required
While medical billers vs medical coders have entirely different job responsibilities, they need to possess somewhat similar skill sets. They both require good teamwork and communication skills to work together to resolve issues within the hospital facility or with the insurance company. Medical coders and medical billers require proficiency in mathematics and attention to detail to ensure all laws related to patient confidentiality are fulfilled.
Salaries
While both of these professions pay you enough to live a peaceful life, their exact salaries may vary according to region, educational background, experience and expertise, and employment level. According to a few surveys, the annual salary for medical billers is an average of $30,806 while that for medical coders is $47,481. Senior professionals working in either of these departments are likely to earn larger amounts than those mentioned above.
Conclusion
With Precision Hub, you can optimize your revenue cycle management to cater to every patient’s needs. Our team comprises the best medical coders and medical billers who specialize in coding services, finance and accounting, lab billing management, credentialing, and much more. With our appointment analysts at your service any time of the day, you will be able to boost your reimbursements, prevent payment delays, cut down costs, and avoid errors that could cost you a fortune in the long run.