The process of medical billing and coding are distinct in their own ways. They might sound similar to a layman, but they are different even though they are both a part of the revenue cycle process. While medical billing is the process of generating, filing and following up on claims with the insurance providers till the payments for medical services rendered are received, medical coding is the process of translating the medical information of the patient into medical alphanumeric codes compliant to the medical coding classification systems such as CPT, ICD etc. Besides this, there are many other differences some of which include:
Coding and Billing Knowledge
Its mandatory for a biller to have both coding and billing knowledge but it isn’t the other way around. Besides keeping track of patient visits and collecting patient information, billers need to manage detailed and specifically coded information before claims submission. Unlike coders, billers don’t have to interact with physicians to understand code accuracy. Likewise, coders need not understand payor terms and conditions. As coding requires more exhaustive knowledge, most practices prefer to have billers inhouse and outsource coding to medical coding companies.
Process Kick Off Time
Medical billing is the process that starts as soon as the patient sets an appointment with the physician. The process of medical coding starts after the patient utilises the medical services from the healthcare provider. Also, medical coders do not have to directly interact with as their job primarily involves lot of backend work. However, medical billers need to get in and stay in touch with the patients till their payments are received by the healthcare provider.
Job Responsibility
The responsibility of medical coders ends after they accurately translate medical information into compliant alphanumeric coders. They may come into action in case of issues flagged by the biller. Medical billers, however, stay responsible from the start of the process. Their responsibility continues even after the claim is submitted to the insurer. The medical billers must track the status of the claim and follow up with the patients and insurers till the payments are received.
Claim Denial
When claims get denied, medical billers need to investigate the root cause for the claim denial. There may be several reasons for a denial and a biller has to look into each of these to resolve the issue. In case of denied claims, medical coders come into the picture, only when the root cause happens to be a coding issue. Therefore, a biller’s responsibility in getting reimbursements is far more comprehensive than coders.
Despite the difference in job responsibilities, billers and coders must effectively communicate with one another to process bills effectively. Direct and timely communication helps to increase the sense of responsibility and commitment towards their core tasks. Likewise, both billers and coders need to undergo regularl training to stay abreast of the ever-changing HIPAA and coding classification guidelines.
The symbiotic relationship between billers and coders can be witnessed in medical billing companies. These companies develop workflows to ensure billers and coders work in unison towards meeting a common goal.