What is the difference between medical billing and coding? Often these terms get used together, and while they are both very important functions within the healthcare industry, they have different job functions, processes, and responsibilities.
Medical billing and coding work together in tandem and are the backbone of the revenue cycle management process that enables healthcare providers to receive accurate payment for the services they render. Despite the key role these professions play in the healthcare system, many people still believe this is just one job function and do not realize what they do, and how they differ from each other.
In this article, we discuss just some of the differences between medical billing and coding. We will cover the definitions, processes, and general responsibilities of each profession. We also look at some frequently asked questions regarding medical billing and coding.
The Difference Between Medical Billing and Coding
Table of Contents
I. Medical Billing
II. Medical Coding
III. Medical Billing and Coding Example
IV. Frequently Asked Questions (FAQ)
VI. Conclusion
Medical Billing
Medical billing refers to the process of submitting claims to insurance companies and other healthcare payers for payment of services rendered by healthcare providers. This process involves gathering all of the pertinent patient information, preparing and submitting claims to insurance companies, tracking payment status, and following up on denied or underpaid claims. Medical billers must be knowledgeable in government and payer policies, billing rules, and regulations, and have a general understanding of ICD-10-CM/PCS, CPT(R), and HCPCS code sets. Medical billers are often certified through the AAPC with the Certified Professional Biller (CPB™) Certification.
Medical Coding
Medical coding refers to the process of translating healthcare diagnoses, procedures, and other medical services into standardized alphanumeric code sets. These codes are then used to communicate information about the patient’s condition and the medical services received to insurance companies, healthcare providers, and other stakeholders.
Medical coding is a complex process that requires a high level of knowledge and skill and in-depth knowledge of ICD-10-CM/PCS, CPT(R), and HCPCS code sets. Coders must also be well-versed in medical terminology, anatomy, and physiology, and must stay up to date with all of the coding guidelines and regulations. Medical coders are often certified either through AAPC or AHIMA, depending on whether they work in the inpatient or outpatient setting.
Medical Billing and Coding Example
Below is an example of a standard hospital claim form that is ultimately submitted to the insurance carrier by a medical biller at the end of a patient visit. The codes that the medical coder assigns to the patient visit get inputted onto the claim form before submission. The red outlined areas are where the diagnoses, procedures, and supplies are placed, depending on whether the patient visit is an inpatient encounter or an outpatient encounter.
Frequently Asked Questions (FAQ)
Can one person perform both medical billing and coding?
While it is possible for one person to perform both the medical billing and coding functions, it requires a high level of expertise in both areas. Many healthcare organizations choose to have separate departments for medical billing and coding to ensure that each area is handled by a specialist in their respective field.
What education is required for medical billing and coding?
For either profession, one must have a high school diploma and complete a certificate program or associate degree program in medical billing and coding. These programs cover the necessary skills and knowledge required for both professions.
What certification is recommended?
In addition to having the necessary education requirements for medical billing and coding jobs, most employers also require applicants to be certified by either the American Health Information Management Association (AHIMA) or the American Academy of Professional Coders (AAPC).
AHIMA offers several certifications including Certified Coding Associate (CCA), Certified Coding Specialist-Physician Based (CCS-P), Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA) and Certified Professional Medical Auditor(CPMA).
The AAPC offers certifications such as Certified Professional Coder Apprentice (CPC-A), Certified Professional Coder(CPC), Certified Professional Biller (CPB) and Certified Inpatient Coder (CIC), just to name a few.
Certification exams can be taken after completing coursework in approved programs or through self-study courses offered by both organizations.
Conclusion
In conclusion, medical billing and coding are essential components of the healthcare industry. While both professions play important roles in the revenue cycle management process, they differ in their focus, responsibilities, skill sets, and certifications. In general, medical billing focuses on the administrative side of the process, while medical coding focuses more on the technical side. A strong understanding of insurance requirements, regulations, anatomy, physiology, and medical terminology is required for both medical billing and coding.
