The Ins and Outs of Medical Billing and Coding

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Medical billing and coding are often referred to as a single term; however, in terms of employment and specific roles they are very different.

The role of the medical biller

Medical billers are responsible for submitting claims to insurance companies, Medicare, Medicaid, and in some instances, patients. The medical biller is responsible for ensuring that their provider gets paid for services, medications and supplies. The biller uses these skills and knowledge to convert information from a transcribed patient medical record to a billing statement. They enter the patient data into the provider’s medical billing management system and ensure that statements for patients and insurers are compliant with the laws and regulations governing health information. The biller also creates reports to track payment status and initiates follow-up on unpaid claims.

The role of the medical coder

A medical coder needs to apply skills in information management, interpersonal communication, accounting and computer technology. He or she must also have knowledge of medical terminology and medical coding classification software and be familiar with insurance forms and plans. The medical coder also needs knowledge of:

  • Anatomy
  • Physiology
  • Medical terminology
  • Etiology
  • Pathology
  • Treatment modalities, and
  • Prognosis of diseases.

Differences and similarities

Medical billers and medical coders work closely together to get bills submitted correctly and on time. The medical biller handles the bill submission and ensures payment, unlike the medical coder who actually communicates with the physicians to obtain data pertaining to reimbursements. Both professionals should have knowledge of HCPCS, ICD-9-CM and CPT codes.

Medical billing is basically a subset of medical coding. Medical coders require knowledge of each medical code as well as anatomy and general disease treatment. This makes the medical coder’s job one that is highly specific.

The more you know…

In some cases, nurses choose to expand their knowledge of the medical profession by taking a medical coding course and changing career track. Similarly, qualified or experienced coders may gain an education in medical terminology and knowledge in order to progress into a promising medical career. The more you know, the more valuable you are.

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Laureen Jandroep

CPC, COC, CPPM, CPC-I.,Sr. Instructor for CCO.us. Laureen has over 25 years in the healthcare field. She graduated as an Occupational Therapist in 1986 and before long was running a successful therapy practice which did over 1.6 million in billing per year with a less than .06% rejection rate. Once Medicare changed how rehab companies were reimbursed this business was closed and Laureen eventually started a new company dedicated to teaching Medical Billing and Coding. Laureen has taught medical billing and coding since 1999 and currently does so through her comapny Certification Coaching Organization, LLC which does business as CCO.She resides in Florida with her husband of over 20 years Anthony and four children. They are active parents and spend most of their time these days just being parents which they love.

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