Thu. Apr 18th, 2024
medical billingmedical billing

Both billing and coding are a lot different from each other, it is a separate process, but they are linked to each other. Medical billing is the first process, then medical coding is required after medical billing. Afterwards, receiving payment for medical health services is a crucial part of the complete process. 

What is medical billing?

Medical billing service is the first process, then medical coding is required after medical billing.

FRONT-END MEDICAL BILLING

Front end medical billing is when the patient schedules the first appointment or registers at the hospital, office or clinic. 

At Check-In, billers and patient financial administration staff guarantee patients complete required forms and affirm patient data, including place of residence and insurance details. 

The front end medical billing also includes the financial responsibility of a patient. When a patient checks out, clinical coders get the clinical records and transform the data into billable codes.

BACK-END MEDICAL BILLING

Medical billers and back-end medical billers use patient information and medical codes to make a ‘superbill.’ The superbill is a detailed form used to create claims by the provider. This form consists of the following data:

  • Patient information:

-Name

-DOB

-Gender

-Age

-Insurance details

-Treatment, diagnosis and procedures

  • Provider Information

-National Provider Identifier (NPI)

-Name of the provider

-Location

-Signature

-Physician name

-Reference

It is easy to put information electronically or manually from the superbill data, allowing medical billers to create claims. Furthermore, the superbill provider may comment or justify medical care if necessary.

WHAT IS MEDICAL CODING?

Medical coding is the first patient meeting with a physician in their clinic, hospital or other healthcare organization. When they both interact, the details of the visit, provider and services are recorded, and the patient’s electronic or paper health record is maintained. This record contains reasoning, diagnosis, procedures and treatment of the patient by the physician. All the information during the patient encounter is essential for medical billing and medical coding; it should be complete and accurate. If there is no record of the patient in medical billing, it should not be coded. Moreover, if there is any conflict within the clinical documentation, the claim makes an appearance. If a service is not proficiently documented in the medical record by the medical staff, the organization could face a claim denial or claim rejection.

Once a patient is discharged or leaves the hospital or office, the medical coder needs to analyze the patient data with medical codes related to the services and facilities such as diagnosis, procedures, charges, treatments, etc.

Medical billers and medical coders have different abilities, responsibilities, and skill sets to perform according to their requirements. Here are some of the differences which clarify the difference between a medical coder and a medical biller:

1. The work isn’t the same

Medical Coder:

First of all, the work is not the same. Both have different responsibilities, skills and capabilities, which can differentiate them. Medical coders first understand the services provided to the patient in terms of computational codes. There are some codes such as International Classification of Diseases (ICD) and Current Procedural Terminology (CPT). There should be a good knowledge of medical codes, diagnosis codes, procedure codes and how to assign them accurately according to the standards. 

Medical Biller:

Medical billers use the instructions, then file the insurance claims and payments to the accounts provided by the medical coders. Medical information must be accurate and complete for the processing of claims. Medical billers work with insurance companies to finalize the details and statements and minimize claims rejection and denials.

2. Personality matters

Personality matters everywhere, especially medical coding and billing; they are supposed to be unique personalities. You should self-examine your personality first because it is significant for these kinds of medical jobs. 

Extrovert:

If you say you are an extrovert, you should prefer medical billing because medical billers need to be good in communication skills while talking with the patient; patients should be comfortable. They can quickly get comfortable with patients and medical insurance companies and vice versa, and patients can easily share their medical problems. They are also good at resolving patient issues if required. 

Introvert:

If you say I am an introverted personality then, medical coding is the perfect fit for you because they are less communicative with people around them. They need to focus on the coding process, and they are less interactive with their healthcare staff because they have to work independently. It is a good option for students who are uneasy to talk to people all day. Moreover, students who are more interested in analytical, detail-oriented stuff should adopt this as a profession.  

Although this is not a firm rule, plenty of students interested in medical billing are introverted, and students doing medical coding are extroverts and vice versa!

3. Coders do not work with patients, whereas Billers do

In medical settings, working with patients is not for every person. There are many other options in healthcare which, like medical coders, can assist patients indirectly. A medical coder is in collaboration with the physicians, medical biller and other medical staff. The medical biller has to interact and communicate with the patients directly. Medical billers have to communicate with the patients. It is not a smooth process because medical billers have to empathize with patients in every possible way, whether they want to discuss their problem or not. Effective billers help patients understand their costs, charges and treatment costs etc., in their overall healthcare experience.

4. More extensive healthcare facilities are more likely to split duties.

If you want to be a medical biller or coder, first search for your job in hospitals with extensive healthcare facilities. There is more likely greater demand for coding and billing services in large healthcare organizations because of the large and big amount of data documentation so, it is better to hire more coders and billers who can split duties and share the workload. There is plenty of data documentation that can be fed into electronic health records. In small organizations, there are fewer opportunities for both medical billers and coders. The medical biller can work in small clinics and hospitals to record data manually or electronically.

5. Alliance vs autonomy

Medical coders work directly for the medical billing or outsourcing medical billing companies, and they are in alliance with the staff, physicians, workers and administrators. Medical billers are considered as the alliance role. 

Medical billers are the direct facilitator for the patients and other parties necessary for the billing process. Medical billers are considered as an autonomous role.

6. Education & certification requirements

The educational criteria are equal for both medical billers and coders. Many companies may prefer candidates with a diploma or associate degree in both medical billing and medical coding.

However, there are several industry certifications for each profession. Basic educational credentials include:

  • Certified Billing and Coding Specialist (CBCS) from the National Healthcare Association (NHA). The qualified certification for medical billers & coding specialists.
  • Certified Coding Associate (CCA) from the American Health Information Management Association (AHIMA). 

Benefits of Medical Coding Services

Medical coding is somewhat similar to translation or transcription. (find the best transcription services online here). Coders take medical reports from specialists, which might incorporate a patient’s condition, the analysis, a prescription, and whatever strategies the specialist or medical services performed on the patient, and transform that into a bunch of codes, which make up a significant piece of the medical claim. A division of the vital advantages of medical coding include:

  • Ability to create customer-specific reports
  • Less costly 
  • Cleaner claims and fewer denials
  • Reduced accounts receivable days
  • More than 98% accuracy

Benefits of Medical Billing Services

Most practices know how the clinical billing administrations and income cycle can decrease expenses, increase collections because of electronic record checks and different advantages. Some of the benefits of medical billing include:

  • Increased revenue generation
  • Faster claims processing which in turn results in healthier cash flow
  • More time to focus on core competencies and increase efficiency
  • Decreased practice overhead costs by being able to hire fewer employees
  • Ability to avoid negotiations with payers and insurance companies

Wrap up!

UControl Billing is your reliable partner for all bills that are submitted on time with the correct coding. They completely understand the importance of accurate data and error-free claims, so delays or denials won’t happen.

Outsourcing medical billing and coding services can help you with cleaner and faster claims at lower costs. UControl Billing understands the worth of medical billing and coding on time. They are available 24/7 to help you, and they are focused on providing medical billing services to patients and your company. Feel free to reach UControl medical billing company, and get the assistance you and your business need! 

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