Relationship between Medical Billing & Coding

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Medical billing: What is it?

The process of creating medical claims to submit to insurance companies for reimbursement for medical services provided by providers and provider groups is known as medical billing." The medical biller tracks the claim after converting a healthcare service into a billing claim to ensure the organization is paid for the work the provider completed. A skilled medical biller can generate revenue for the doctor's office or healthcare facility.

Is medical billing and coding the same thing?

Medical billing and coding are two separate but connected processes. Both are essential to the healthcare industry since they inform commercial and government payers like Aetna and Medicare about diagnosis, treatments, and supplies.

Medical coders and billers must understand medical terminology, anatomy, and pathophysiology to comprehend physician notes and surgical reports because they collaborate with clinical staff. Medical coders may work for billing businesses and occasionally participate in the billing process. It's not unusual for the same person to work as a medical coder and a medical biller in small physician offices. Although billing and coding are not the same, they play crucial roles in the healthcare revenue cycle.

The Work of Medical Coders:

A medical chart is maintained each time a patient sees a clinician for medical treatment or evaluation. Medical coders go over the patient record and extract information that can be billed, which they then convert into standardized codes.

Procedure codes, such as CPT?, HCPCS Level II, or ICD-10-PCS, inform the payer of the service rendered by the healthcare practitioner. ICD-10-CM diagnosis codes give the payer information about the patient's reason for receiving the services.

The standardized codes that medical billers currently use to produce insurance claims and bills for patients are where medical coding and medical billing collide.

The medical billing cycle, however, starts before medical coding and doesn't finish until the doctor or healthcare facility has received all reimbursements due for the medical care provided.

The Work of Medical Billers:

Medical billers coordinate payments for healthcare services with patients, healthcare providers, and insurance companies (also known as payers). Billers first gather the essential data. This contains the patient's demographics, medical background, insurance status, and the treatments or services.

Billers must check patients' medical records and insurance policies to ensure that the treatments are covered to collect this data. They produce medical claims next, ensure their accuracy, and submit them to payers. The claims are returned to billers with the agreed-upon payment once payers have approved them.

Billers prepare the patient's bill at this time or before the patient sees the doctor. This entails subtracting the portion of the surgery or service paid for by insurance, accounting for copays and deductibles, and adding any unpaid patient balances. Patients receive invoices as necessary, and payments are posted and reconciled. But there is a lot more that goes on in the medical biller's workday before, after, and in between.