Contrasting Medical Coders and Billers

Medical facilities depend on both medical coders and billers to keep their revenue cycle management functioning efficiently. Although they share a common goal, these two positions involve unique obligations and prerequisites.

In this article, we will analyze the principal differences between medical coders and billers regarding:

• Key Responsibilities
• Necessary Capabilities and Attributes
• Education and Credentials

Defining Medical Coders vs. Billers

Before examining the major differences between coders and billers, it's helpful to clearly define each role. Both play integral parts in smooth revenue cycle operations, however their specific duties require distinct abilities, credentials, and daily work.

The Role of a Medical Coder Medical coders translate healthcare services, diagnoses, and procedures into standardized medical code sets to relay key details to insurance providers. This coding enables precise billing and reimbursement. Major duties include:

• Reviewing clinical records to comprehend procedures, diagnoses, services, etc.
• Ensuring complete, consistent coded data for maximum reimbursement
• Using knowledge of medical terminology, anatomy, diseases, and coding rules to select the most accurate codes
• Meeting productivity benchmarks and tight deadlines for code assignments
• Assigning precise medical codes utilizing classification systems like ICD (diagnosis codes), CPT (procedure codes), and HCPCS (healthcare services codes)

The Role of a Medical Biller

Medical billers take finished codes and manage the entire billing process from start to finish. This involves submitting insurance claims, monitoring payments, appealing denied claims, and following up on outstanding claims. Primary duties include:

• Verifying patient insurance eligibility and coverage
• Preparing accurate claims by compiling documentation, codes, charges, etc.
• Submitting claims to insurance carriers in a timely manner
• Tracking claims status throughout the adjudication process
• Appealing denied claims when suitable to maximize reimbursement
• Initiating collection efforts for outstanding payments
• Analyzing explanations of benefits and payer rejections/denials to determine next actions

Key Differences Summarized

As shown above, while coders and billers collaborate to process healthcare services for payment, their daily tasks differ considerably.

Coders focus on abstracting the medical record, designating accurate codes, querying physicians if necessary, and guaranteeing regulatory compliance.

Billers utilize those finalized codes and oversee all aspects of submissions, payments, appeals, collections, and patient account maintenance.

Essential Skills and Attributes

Coders and billers also require some unique skills and strengths, including:

• Coders – Keen attention to detail, medical terminology knowledge, analytical abilities, and quick learning capacity.
• Billers – Organizational skills, customer service skills, communication abilities, problem-solving skills.

Education and Credentials

Finally, starting either career follows different education and credentialing pathways:

• Coders commonly pursue a medical coding certificate or associate’s degree. Gaining Certified Professional Coder (CPC) credentials is also standard practice.
• Billers often complete a certificate or degree in medical billing and coding. Having a Certified Billing & Coding Specialist (CBCS) certification is also typical.

Key Takeaway

Although they work synergistically, medical coders and billers have quite distinct daily functions and skillsets. Understanding those differences assists healthcare employers in building effective revenue cycle teams.

Looking for work? Get connected with one of our career experts.