What is Medical Billing and Coding
Medical billing and coding are key drivers behind the modern health care industry. Without either field, health professionals would not be able to transfer important data and get paid for their services. Although people use medical billing and coding together, they are still two separate jobs.
Medical coders translate written copy–such as a doctor’s diagnosis or patient prescriptions–into a numeric or alphanumeric code. For every medical case or injury, there is a corresponding code to match. Billing specialists then take the information from medical coders to make a bill or claim for the insurance company.
What Does a Medical Biller and Coder Do?
Since medical billers and coders have two different job roles, they are usually found in various areas of a hospital, clinic, or doctor’s office. However, in a small setting, one person may perform both jobs.
Let’s take a closer look at what medical billing and coding experts do in their day-to-day schedules.
Medical Coding
Professional coders typically start their day by reviewing medical charts, files or reports they have to code. Next, they examine each document and determine the patient’s diagnosis based on what was performed. Their job is fairly simple: a coder finds the best way to translate a doctor’s report into code.
For example, a record may show that a patient visited the doctor for lower back pain. But after physical examination and x-rays, the doctor discovered that the pain may be linked to a muscle strain in the affected area. With a positive diagnosis, the doctor prescribed Methocarbamol (or Robaxin), a muscle relaxant that treats back pain, followed by physical therapy for two weeks. The coder would read this report and use a coding manual, such as ICD-10, to identify the diagnosis and procedure. Coders must follow a special set of guidelines for each code, or it could result in a rejected claim by the biller.
Medical Billing
As soon as a professional biller receives the code, it’s their job to create and submit a medical claim to the insurance company. It is also the biller’s responsibility to send out reminders and collect payments from each patient. While this process may seem easy to understand, it can be very complex. That said, a medical biller’s job duties include:[2]
- Investigating and appealing rejected claims.
- Preparing patient payment plans and collection accounts.
- Reviewing patient bills for correct and complete information.
- Ensuring rate changes are up-to-date with billing software.
- Updating payment spreadsheets and running collection reports.
- Gathering referrals and pre-authorizations required for a doctor’s procedure(s).
- Checking every insurance payment for clarity and compliance with contract policies.
- Verifying eligibility and benefits for treatments, in-patient hospital stays, and other procedures.
- Answering all patient or insurance inquiries related to any assigned account can be done either by phone or email.
- Setting up, reviewing, and delivering patient claims using billing software, by either electronic or paper claim processing.
In addition to these tasks, an employer may ask a biller to perform other duties, depending on their certification and previous work experience.