Difference between Medical Coding and Medical Billing

December 16, 2020

Difference between Medical Coding and Medical Billing

Are you seeking a job in the medical field? If yes, you might be wondering if a career in medical coding and medical billing is the right choice for you. However, note that before making any career move, you should understand what types of skills and responsibilities you would need in your new field.

Did you know that the medical billing industry will be worth about $16.9 billion by 2024? In contrast, medical coding will be worth almost $25.4 billion by 2025. You might be wondering what the difference between medical billing and coding is.

You should know that medical billing and medical coding professionals play an important role in the reimbursement cycle, ensuring that medical providers receive payment for the services that they provide. There is no doubt that the opportunity for advancement and stability in these fields has made healthcare a very popular career choice for many people.

If you are an experienced professional looking to make a change or a student trying to decide on a path to follow, medical billing and medical coding may be right for you. It is worth noting that there are some generalizations about medical billing and medical coding.

Did you know that some people even use the two terms interchangeably? However, the fact is that they are different job functions in the modern medical field. Note that both these roles are ideal for individuals who thrive in administrative environments.

Also, keep in mind that sometimes (mainly in smaller medical practices), these roles are often combined. But while these positions are certainly related, they are different. Let’s understand the difference between medical billing and coding.

What is Medical Billing?

The medical process entails the submission of medical claims and following up on them with insurance providers for payment. Note that medical billing is for various medical services such as treatment, testing, and medical procedures.

Did you know that medical billing focuses on the collection of payments from patients and insurers? However, it is worth noting that medical billers spend plenty of time dealing with medical coding. This is because medical coding is the language these professionals use to inform insurance providers what happened during a patient’s encounter. 

Medical billing professionals must ensure that the healthcare provider receives maximum reimbursement for the service they render.

Medical Biller Responsibilities

Note that medical billers perform the following tasks:

  • Enter medical codes into specialized billing software to submit claims to insurance providers
  • Understand insurance procedures to make sure claims can be submitted timely and accurately
  • Directly work with patients in order to obtain their insurance information. Medical billers may also explain charges to patients
  • Contact insurance providers to follow up on medical claims that they have not paid

Benefits of Medical Billing Services

You probably know how medical billing services can reduce your costs and increase collections. Here are some of the key advantages and benefits of medical billing.

  • Quicker claims processing that results in better cash flow
  • Increased revenue generation
  • More time and resources to focus on your core competencies and improve efficiency
  • Decrease in practice overhead costs as you have to hire fewer employees
  • You can avoid negotiations with insurance companies and payers

What is Medical Coding?

Medical coders are responsible for deciphering the documentation of interaction between the healthcare provider and patients. After that, they determine the diagnosis code and suitable procedure in order to reflect the medical services offered. So, we can say that medical coding is the transformation of medical diagnosis, procedures, and services into universal alphanumeric codes. 

This means that medical coding ensures that medical encounters are recorded timely and appropriately for billing purposes. Note that these records are outside a patient file and use a series of standard codes in order to increase privacy for patients while ensuring cohesive billing practices among insurance companies and healthcare facilities.

For a medical coder to ensure medical coding accuracy, they may need to query physicians regarding medical procedures. And that is not all; they also educate and inform other medical staff on collecting the necessary information. If a medical coder is not sure about any aspect of the patient’s record, it is crucial they seek clarification.

Medical Coder Responsibilities

Note that medical coders perform the following tasks:

  • They analyze patient records and assign the right procedure code or medical diagnosis code for the medical services the patient received. Remember that accurate coding is crucial, as it is used in a patient’s insurance claims
  • They use Current Procedural Terminology (CPT) in order to select the right medical codes for various patient procedures
  • They use the International Classification of Diseases (ICD terminology) to select the right medical diagnosis codes for diagnoses
  • Ask other office staff and employees for more detailed information on patient records to determine the right coding

Benefits of Medical Coding Services

You may know that medical coding is similar to translation. Medical coders obtain medical reports from doctors. These reports may include a patient’s medical condition, the doctor’s diagnosis, and a prescription. They turn that into a set of medical codes, which make up an important part of the medical claim.

Here are some of the key benefits and advantages of medical coding.

  • Reduction in accounts receivable days
  • Cleaner medical claims as well as fewer denials
  • Avoidance of expensive back billing
  • Generates customer-specific reports

Education Requirements

Did you know that training programs for these roles vary considerably in length and depend on the level of education that you seek? You should know that many programs can offer you the basics in just three months, which is convenient. On the other hand, you will also find many one-year certificate programs and 2-year associate’s degree programs.

You will be pleased to know that educational requirements are quite similar for both medical billers and coders. However, it is worth noting that many employers might prefer applicants with an associate degree or diploma in either billing or coding.

Also, note that there are different industry certifications for medical billing and coding. Main certifications are as follows:

  • Certified Professional Coder (CPC)
  • Certified Billing and Coding Specialist (CBCS) from the NHA (National Healthcare Association). This is the eligible certification for most medical billers as well as coding and billing specialists.
  • Certified Coding Associate (CCA) from the AHIMA (American Health Information Management Association). This is the ideal certification for most medical coders.

While certification is not mandatory, keep in mind that it is a mark of expertise and achievement. So, it will enhance your opportunities in the healthcare job market. It is important to do your research before you enroll in any program. You should join an accredited school. Also, ask relevant questions about employment rates, costs, and certification rates.

Training

Did you know that medical coders receive training mainly through certificate and diploma training programs? Also, it is worth noting that others pursue their job training in Health Information Technology (HIT) associate degree programs. You should know that some of the coding credentials include a certified professional coder. The American Academy of Professional Coders offers this.

Similarly, medical billers receive their training through diploma and certificate programs channeled toward insurance and medical billing. Did you know that Certified Reimbursement Specialist is one of the special credentials for medical billers?

Salaries and Job outlook can Vary

Note that the jobs of medical coders and billers are closely related and tend to have similar educational requirements. However, since they are fundamentally separate roles, keep in mind that medical coders and billers earn different average salaries.

Did you know that the Bureau of Labor Statistics (BLS) reports medical billing and posting clerks, which include medical billers, earn a salary of $39,520 (average) per year ($19.00 an hour)? You will be glad to know that the BLS projects a 10 percent increase in employment between 2018 and 2028.

Also, the BLS reports that medical records technicians earn a salary of $44,010 (average) per annum ($21.16 an hour). And the BLS projects an increase of 11 percent in employment between 2018 and 2028.

Final Thoughts

As you can see, there are many differences between medical billing and coding. People often use these two terms interchangeably. Note that this is sometimes acceptable due to the functions involved. Medical billers and medical coders collect information and code claims accurately and reliably so that physicians receive payments in a timely manner. There is no doubt that both of these jobs are critical to the cash flow of all healthcare providers.

Note that a medical coder assigns medical codes to the procedures that doctors perform on patients. And using these medical codes, medical billers perform the costing for the medical services offered. After that, they forward the information to the insurer for reimbursement.

Both medical coders and billers work in settings like pharmacies, hospitals, clinics, and other similar medical facilities. Also, keep in mind that both medical professions require a minimum certification, such as a high school diploma. Also, they require interpersonal skills, such as communication, in order to enable and facilitate coordination between various departments.

However, the differences between these two medical careers also make them quite complementary to each other. As a result, as you pursue a career in these fields, you may find that combining the two jobs may be the most suitable choice for you.

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