Differences between Medical Coding and Medical Billing

The healthcare industry is vast and has several components. There are several professions under the same umbrella and all these professions work side by side to ensure that each patient gets the care they deserve. Two of the most prominent professions in the medical industry are Medical coding and Medical billing. Many people confuse the two professions to be the same thing but there are prominent differences between the two. Let’s take a closer look at what each profession is and how they differ.

Medical Coding

What Is Medical Coding?

Medical coding is the compilation of all the patient’s information from their medical checkups and tests. A medical coder collects all information and notes it down. After that, they collect all the details of the information to present to the insurance company. This helps justify what each claim is for, making it easier for the insurance company to transact the payments.

Medical coding also constitutes the extraction of patient information so that coders can create claims and bills for insurance companies. The coder not only records the information but also analyzes and assigns codes to the important data. 

Medical Billing

What Is Medical Billing?

Medical billing is essentially the next step to medical coding. It concerns the billing process on behalf of the patients. Medical billing updates all financial information including the calculation of different bills, assisting patients with their financial transactions, etc. These professionals take care of all the payments and insurance claims. They act as a bridge between the patient and the insurance company, discuss the insurance coverage of patients and coordinate payments.

Medical billers work closely with insurance companies to figure out if there are any rejections. They handle the communication and also hand out statements to both parties involved.

Differences Between Medical Coding And Medical Billing

Job Description

Both the professions have different job descriptions. Let’s review them:

Medical Coders

Medical coders first record all the patient information needed and then translate it into a standard code. There are multiple codes the coders can use as per the need of the insurance company. CPT is one of the most popular codes followed by ICD-10. The information should be accurately coded, and for that, the coder must have advanced knowledge of medical jargon.

Medical Billers

Medical billers take the work done by coders forward and use their instructions to file insurance claims. They also post the payments to the accounts. The coders need to give them accurate information as they will turn it into insurance claims and sort through the denials and rejections.

Customer Dealing

Billers and coders have to communicate to different people and in different ways:

Medical Coders

Medical coders don’t have to work with patients, but they work with the medical staff and get all the exclusive information require.

Medical Billers

Medical billers have to communicate with patients and discuss costs exclusively. It can be challenging as it is already a testing time for patients, and they are hardly ever ready to discuss payment plans. Medical billers need to be empathetic and make sure they get the job done.

Alliance Vs. Autonomy

Medical Coders

Medical coding is an alliance role, and Medical billing is an autonomous role. Medical coders work in direct alliance with physicians and the administrative staff.

Medical Billers

Medical billers have the autonomy to work independently. They have to establish communication lines between different parties and ensure that they reach an endpoint.

Qualification

Both the professional roles have similar qualification requirements. A medical coding company might prefer certifications for their coders and billers but from different institutions.

Medical Coders

Medical Coders should get their certification from the AHIMA. The American Health Information Management Association offers a comprehensive course and certification for coders. These coders are then called the CCA, Certified Coding Associates.

Medical Billers

Medical billers should get their certification from the NHA (National Healthcare Association). Individuals certified from NHA are  Certified Billing and Coding Specialists.

Skills Needed

To do anything in life, you need a particular set of skills. Let’s take a look at the skills you need for:

Medical Coders

Analytic Skills- Medical coders have to note and review a lot of information. To translate it into codes, they need to be analytical and sift through all the essential information to decode.

Collaborative Skills- Collaboration is one of the most significant parts of a medical coder’s job. They need to have enhanced collaborative skills so that they can bring solutions.

Technical Skills- It is important for coders to be tech-savvy to translate the information into decided codes. They must have all the technical skills required to turn the information into accurate codes.