Medical Billing and Coding
Medical billing is the process of following up on insurance companies offering health insurance services in order to receive payment for services rendered by a healthcare provider.
Medical billing and medical coding are not the same thing. While the medical coder and medical biller may be the same person or may work closely together to make sure all invoices are paid properly, the medical coder is primarily responsible for abstracting and assigning the appropriate coding on the claims.
In order to accomplish this, the coder checks a variety of sources within the patient’s medical record, (i.e. the transcription of the doctor’s notes, ordered laboratory tests, requested imaging studies and other sources) to verify the work that was done.
Then the coder must assign CPT codes, ICP-9 codes and HCPCS codes to both report the procedures that were performed and to provide the medical biller with the information necessary to process a claim for reimbursement by the appropriate insurance agency.
Medical coding requires a good deal of education and training to become a fully skilled medical coder. To begin with, coders must have thorough knowledge of anatomy and medical terminologies.
It is not necessarily important for medical coders to have degrees or masters in the field. What is required is a solid understanding of anatomy, physiology and medical terminology.
It is also highly recommended for serious coders to complete a medical coding course of study, pass the CPC exam and earn their certification as a Certified Professional Coder, or CPC.
Certified Professional Coders, or CPCs, are in high demand because employers know that these individuals can perform the job of medical coder with the utmost proficiency. It is important to become familiar with different types of insurance plans, regulations and compliance rules.
Although a medical biller’s duties vary with the size of the work facility, the biller typically assembles all data concerning the bill. This can include charge entry, claims transmission, payment posting, insurance follow-up and patient follow-up.
Medical billers regularly communicate with physicians and other health care professionals to clarify diagnosis or to obtain additional information. Therefore, the medical biller must understand how to read the medical record and, like the medical coder, be familiar with CPT, HCPCS Level II and ICD-9-CM codes. Medical billing and coding certification is important as the financial health of a practice largely depends on the performance of the billing office.
Increasing demands on providers with decreasing reimbursement requires health care offices to have highly skilled individuals for medical billers.