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Medical billing and medical coding are crucial for any healthcare practice, be it an individual practitioner or a healthcare organization. These two are often lumped together, however, they are quite different from each other. They may be linked to each other very closely but serve different purposes altogether.
If we talk in simple terms, medical billing is about getting the reimbursements and payments whereas medical coding denotes the documentation done to file a claim with the insurance provider.
The practitioner must also understand the difference between medical billing and medical coding in healthcare as it plays an important role in revenue cycle management. These processes ultimately help the providers seek proper reimbursements for the services they render.
What Is Medical Billing?
Medical billing is the process of receiving payments from the patient or insurance companies for the services rendered.
Once a claim is sent for processing, the medical biller has to track the claim until it is reimbursed. If there is any discrepancy in claim filing, it has to be rectified and resubmitted as soon as possible. The goal of medical billing is to ensure that providers get paid for their services such as treatments and care.
Optimizing the revenue stream of a healthcare practice becomes the duty of the medical billers. They must ensure correct and accurate reimbursements for the services rendered.
Many insurance providers set a time limit on claim submission, or the claim expires. An efficient medical biller performs timely submissions and prevents unnecessary revenue loss.
Types of Medical Billing
A variety of claims can come from healthcare facilities. This includes explanation of benefits statements, electronic remittance advice and patient statements.
Medical billing can be divided into two parts:
Front-End Billing
Front-end billing covers tasks such as verifying the patient's eligibility and taking pre-authorization from insurance providers if there is any such requirement. If there are any copays from the patient’s side, they are addressed at this stage.
Back-end Billing
Back-end billing happens after the healthcare provider has received the treatment. Once the billing team receives the codes denoting the patient’s visit, they create claims for reimbursements and send them to insurance companies or federal agencies.
Responsibilities of a Medical Biller
Medical biller works as a mediator between healthcare providers and insurance companies. Before making an appointment, the biller accumulates the patient’s insurance information and medical records and then verifies if a treatment is covered by the insurance.
The typical duties of a Medical Biller include:
- Collecting patient information such as medical history, insurance coverage, demographics, and the medical procedures the patient received.
- Ensuring accuracy in patient information and rectifying missing details.
- Reviewing authorizations for treatments and referrals.
- Submitting patient information, necessary documentation and claims to the insurance providers.
- Checking patient eligibility and patient benefits for certain procedures.
- Creating bills for patients by segregating the amount covered by the insurance provider and the amount that patient needs to pay out of their pocket.
- Transferring the billing data and health insurance claims to the billing software.
- Working with medical coders to make corrections to denied claims.
- Regularly updating the billing software to change the rates.
- Ensuring that healthcare providers receive payments for the medical services they offer patients promptly.
- Maintaining electronic copies of documentation.
- Managing the disputes on billing and claims.
- Tracking late payments
- Taking follow-ups with health insurance providers
- Solving queries of the patient and health insurance companies
Benefits of Medical Billing Services
Healthcare organizations can save loads of costs and improve revenue with the help of electronic eligibility verifications and benefits. Some of the major advantages of medical billing include:
- Improved revenue generation
- Faster claim processing resulting in smooth cash flow
- More time to focus on your practice and patient care
- Decreased overhead costs
- Reduced negotiations with payers' insurance companies
What is Medical Coding?
The process of assigning numeric or alphanumeric codes to the procedures and treatments done on the patients is known as medical coding. The main purpose of medical coding is to convert medical documents into a predetermined language so that it can be used for accurate billing and reimbursements for healthcare practices.
Whenever a patient goes to a healthcare provider, the doctor will take a look at the patient's medical history to provide the best possible treatment.
However, there are a lot of diagnoses, procedures, services and tools that exist. The codes help the provider determine the exact procedure so that it can be billed efficiently to the insurance company. This speeds up the process of determining the treatment.
Instead of going through the entire patient history, the healthcare provider will take a look at the code, and they will tell what diagnosis the patient is or was undergoing.
Medical coding also helps the finance team understand the split of reimbursements according to the different procedures and diagnoses. This is like a shorthand communication between the provider and insurance company.
Types of Medical Codes
Medical codes can be segregated into two different parts, ICD 10 and CPT (Current Procedural Terminology). These codes are created by the American Medical Association and updated regularly to showcase the advances in medical science.
Let's take a closer look at these codes:
ICD-10 Diagnostic Codes
These codes are used to classify the signs, conditions, and symptoms that a patient may have. Diagnostic coding is important for tracking the health status, reimbursement processing, and provision of care.
ICD-10 is an extended version of the ICD-10 code set which contains additional codes, greater specificity and updated coding conventions which provide a detailed report of the patient’s health condition.
CPT and HCPCS Codes
The CPT coding system is a monthly publication that provides information about the latest CPT codes and coding guidelines. This resource is paramount for medical billers and coders.
It includes the latest updates on code changes, clarifications, articles on specific topics and much more.
HCPCS is a procedure derived for classifying non-physician services and supplies. It includes durable medical equipment and ambulance transport. Just like CPT codes, these codes are essential for billing and reimbursement purposes. It is also used to keep yourself updated about the costs and monitor the quality of care.
What Does a Medical Coder Do?
The job role of a medical coder is to convert the documentation from healthcare providers into standardized alphanumeric codes which can be used by insurance companies to provide reimbursements.
Their responsibility includes:
- The diagnosis of the patient’s condition
- Explanation of medical treatments, services, and supplies
- Determine circumstances affecting medical treatments and services
- Healthcare resource utilization
- Risk Management
- Reviewing physician documentation and clinical statements.
- Verifying the diagnoses, treatment and procedures.
- Determining deficiencies in documentation and billing issues.
- Conducting research and analysis of patient data for reimbursement .
Benefits of Medical Coding Services
Medical billing can be considered like a translation. In this process, the coders take medical reports from doctors which may include the patient’s condition, the doctor's diagnosis, the procedures, and the prescriptions given by the doctor.
This information is then turned into a set of codes and creates a crucial part of the claim.
Some major benefits of medical coding are:
- Lessened accounts receivable days
- Avoid costly back billings
- Over 98% accuracy
- Cleaner claims and fewer denials
- Ability to generate customer specific report
Difference Between Medical Billing and Medical Coding
Medical billing and medical coding co-exist in the world of medical billing. One cannot survive without the other.
However, both concepts serve a distinctive purpose. Medical billers and coders need a unique set of skill sets according to their responsibility. It also affects how they work with patients, providers, and external companies.
Let's understand their responsibilities in detail:
Medical Billers
Medical billers are the mediators who need to communicate directly with a variety of parties to simplify the billing process. They often deal with patients, insurance companies and government agencies to track claims and invoicing.
They also resolve issues which may arise during the payments such as incomplete documentation or missing information etc. Medical billers should have strong interpersonal communication, conflict resolution and technical skills to evaluate medical claims.
Medical Coders
Medical coders play their role in the background. They don't have direct communication with the patients and spend their day working on a computer system. Medical coding is a great field for someone who has an analytical mind.
They do not need soft skills and other management skills as their job requires a deep understanding of all the medical terminologies and coding systems along with knowledge of anatomy and physiology.
How Are Medical Billing and Medical Coding Related
Both Medical billing and medical coding are important aspects of healthcare organizations as they are directly associated with the revenue cycle of the organization. In the claim filing process, coding is done before it is billed to the insurance providers.
Medical billers use codes assigned by medical coders and prepare an accurate claim for submission to insurance companies. Some billers are responsible for reviewing codes for accuracy before sending the claims. However, this is not always the case.
After translating the services into standardized code, medical coders establish communication between the billing and insurance teams. Insurance companies depend on medical codes to determine how much they need to pay for the services provided to the patients.
Which is Better?
There are advantages and disadvantages to both these factors. Let's take a look!
Medical Billing
Medical billers are essential for a healthcare practice that provides vital services to patients and medical facilities.
As a medical biller, your job role involves submitting patient claims, collecting payments from patients, and infusing patient information into appropriate systems. However, one must have a thorough knowledge of all coding conventions to ensure accurate billing.
Medical Coding
The role of medical coders is to assign accurate codes to the services provided to patients. As a coder, your responsibility includes abstracting relevant data from medical records, entering the data in coding systems, and maintaining the coding database.
You must have strong attention to detail and superb organizational skills to succeed in this role.
Bottom Line
If handling medical billing is a hassle for you, it is advisable that you partner with a medical billing and coding company.
Unify Medicraft is premium medical billing software that takes care of all the documentation and shifts a huge load off your shoulders. It is known for maintaining comprehensive accuracy and efficiency in all medical billing steps.
The cutting-edge system allows EHR integration and eliminates the scope of manual errors. Moreover, you can review your healthcare practice’s RCM reports on customized dashboards.
It simplifies complex coding and delivers a higher clean claims rate for your medical specialty. Unify Medicraft’s database is designed to safeguard patient data and prevent your healthcare practice from legal consequences. Our software offers tailored medical billing and coding solutions for maximum results. It also adheres to all compliance standards and stays current with necessary trends.
Choose Unify Medicraft and forget the burden of medical billing & coding!