Demystifying Medical Billing & Coding: A Beginner’s Guide

Medical billing and coding are two of the healthcare industry’s most essential pillars. For providing healthcare services to patients, taking reimbursements from payers, and even securing diseases’ place on records, healthcare billing and coding play a vital role in its execution. Although the medical coding and billing process is as clear as day, some people still confuse them by infusing both these terms together and making the concept more complex for newcomers.
In this article, we will differentiate between medical coding and billing, understand both of these terms, what they mean, their purpose, why they are important, and their future in the medical industry. This is an important concept to understand especially for people who are relatively new to this field and are looking to switch careers. It is beneficial for people who just want to know more about this aspect of the healthcare industry.

What is Medical Coding?

Medical coding is a medical industry concept used to convert different types of diagnoses, treatments, and diseases into various medical codes to simplify the medical billing process. This process can be useful when billing for the services rendered, keeping an accurate patient record, or even communicating about diseases to governing bodies and other concerned parties. Experts who handle medical coding are called medical coders.

What is Medical Billing?

Medical billing, on the other hand, is the whole billing process of the patient for the treatments given to them. Medical billing is a process done by expert medical billers. Healthcare billing proceeds by creating medical billing claims for patient treatments and sending them to the payer (their insurer) or the patient (if they don’t have insurance coverage). The whole billing process revolves around the concept that makes sure the provider gets paid for the services rendered.

Duties of a Medical Biller

As mentioned above, professionals who handle medical billing for the provider are medical billers. They are there for the sole purpose of handling healthcare billing tasks efficiently. Since the provider has other work to focus on (i.e. patient care), it’s the job of medical billers to handle this side of administrative work on behalf of the provider.
Work that comes under the jurisdiction of a medical biller includes:
  1. Creating medical billing claims
  2. Submitting medical billing claims
  3. Ensuring timely payments
  4. Doing regular followups
  5. Keeping records up-to-date
  6. Planning payments
Duties of a Medical biller

Duties of a Medical Coder

Medical coders, on the other hand, carry a different type of duty than medical billers. Their primary job is to assign proper codes to the services rendered by the provider. It is not a wrong thing to say that medical billing solely depends on the accuracy of medical coding. With that concept, any medical billing error (no matter how small) can directly affect the whole medical billing process, which can then cause complications for the healthcare provider.
A medical coder has to make sure to perform the following duties efficiently:
  1. Collecting accurate patient data from providers
  2. Converting patient data into accurate codes
  3. Sharing finalized codes with billers for reimbursement
  4. Ensuring uniform communication thoroughly
Duties of a Medical Coder

Conclusion:

Although medical coding and billing have a core impact on healthcare practice, it’s important to learn and master its essentials to execute tasks accurately. Since errors/mistakes in this field can cost your practice dearly, you must consider outsourcing your medical billing and coding work to an expert company like MaxRemind Inc. With many happy and satisfied clients, MaxRemind Inc. can handle your billing & coding needs too, freeing you from frustration and distractions and allowing you to focus on patient care.
FAQs
What is medical billing?

The medical billing process consists of generating medical billing claims on behalf of providers, which are sent to payers so that providers can get reimbursed for their medical services.

What does a medical biller do?

The main responsibilities of a medical biller are to apply and manage insurance claims, review patient statements for accuracy, and make timely & prompt adjustments in medical billing claims where necessary.

What is the use of medical coding?

Medical coding is used to assign appropriate codes to procedures, diagnoses, and treatments of diseases. These codes can either be used to get reimbursements or to maintain accurate patient medical records.

What is an example of medical coding?

Let’s consider this example, a doctor diagnoses a patient with migraine, and instead of proceeding with the word “migraine” for his records, he will assign the code “G43.909”. This code translates to "Migraine, unspecified, not intractable, without status migrainosus".

Why do doctors use medical coding?

Doctors use medical coding to accurately define the type of illness, disease, treatment, and diagnosis in a short form (in the form of a code). This way, it's easy to convey specific details to another party without confusing them with complex details and confusing terminology.