Medical coding or medical billing? Which job is right for you? What's the difference? A professional biller explains.
You may have heard about medical billing and coding and are considering it as a professional possibility.
You may also still be a bit unsure as to what exactly medical billing is and how it differs from medical coding, and which one you may be more suited for.
Medical billing, in general, is working somewhere in the reimbursement cycle in order to help doctors get paid for the services they provide.
Very simply, doctors get paid by seeing patients and billing their health insurance for their medical services.
The medical bills that are sent to the insurance companies are in the form of health insurance claim forms, called the CMS-1500. Coders enter the correct codes on the claims, based on the patient's visit, and the billers send the claims to insurance companies.
Insurance companies pay the claims based on the charges on the CMS-1500 claim form, and send the payments to the doctor's office.
Medical billers are the ones who enter the payments, line by line, making sure that each payment is what it should be. Then they reconcile each account, making sure that each claim is paid in full by the insurance company. If the claim has resulted in a patient balance, then the medical biller then sends a bill to the patient.
The medical biller must follow all claims until they are all paid in full, either by the insurance company or by the patient. If the claim results in a credit to either the insurance company or the patient, then the biller will be the one to send the refund to the correct party.
If the insurance company did not pay the claim in full, and it needs to be appealed, then the medical biller will be the one to do this also.
Some of the following job responsibilities are included as part of a medical biller's job, although they may include only one or all of the following:
Medical coding is similar to billing in that both of them are aimed at getting reimbursed for the services that a doctor provides to a patient in the medical office.
They way they differ, though, is that a coder is focused only on entering the correct codes on the claim. Although this sounds easy enough, it is not as simple as it seems.
In the outpatient setting, there are three sets of codes that a coder needs to know, and each one of these codes sets contains thousands of codes. These codes include diagnosis codes (ICD-9), procedure codes (CPT), and supply (HCPCS) codes.
In the inpatient setting, coding is much more complicated, and coders have to use up to different sets of codes, depending on where they are working.
Some offices have encounter forms, or superbills, on which the doctor circles or writes down the correct codes for the visit, but some offices do not.
In some settings, coders have to read the doctor's notes, and determine the correct diagnosis and procedure codes for the visit, as well as make sure to code for any supplies used during the visit. This is, of course, much more complicated.
Either way, medical coders are responsible for entering the correct codes on the CMS-1500 claim forms, as well as all appropriate modifiers, which may make the difference between getting paid for the claim or not.
Once the claims are coded correctly, medical coders then give them to the medical billers to send to insurance companies and follow up until they are paid in full.
Besides simply coding and billing, there are many other job possibilities within the field of healthcare reimbursement. These include:
Credentialing. Each doctor has to be credentialed by a national organization, depending on their specialty. This makes sure that they are all fully licensed and legal to practice medicine.
Insurance companies have to check the credentials of each doctor before they will accept them into their networks, and doctors must be re-credentialed on a periodic basis.
Auditing. Both insurance companies and provider's offices perform audits on their files and medical records in order to make sure that they are in compliance. Auditors go through the files to check for mistakes, missing information, and errors.
Practice Management. Practice management is the art of managing entire medical practices. Rather than doing the dirty work and entering charges, payments, and codes, practice managers make sure everything is running smoothly together and that all employees are keeping within the standards of their professions.
Compliance. Very simply, compliance in the medical office is following the rules. Compliance officers, then, make sure that medical offices and their employees are following all of the various rules in the medical industry, including HIPAA regulations and medical records retention.
Now that you know the difference between billing and coding, as well as a little bit about the different types of other jobs out there, you can start to think about which job is right for you.
If you like problem-solving and tying up loose ends, then you may want to pursue medical billing.
If, on the other hand, you like putting together little details to create a large picture, then perhaps medical coding is a better choice.
Luckily, you don't have to choose just one or the other.
Because the field of medical reimbursement is so large, you'll always have opportunities for advancement from one department to another, or to change offices completely. Either way you look at it, medical billing and coding is a great job possibility, and one that deserves a closer look.
You can start on your new career path by looking at the various options for courses you have, or by digging around our tips and tutorials section to get your head around some reimbursement topics before you start your education.
If you found this page useful, please click "Like"! Thanks.