How is a medical billing different from medical coding?
This is a question people ask me about daily. Although these are two very different jobs, understanding both is essential in becoming an expert in your field. If you are thinking of starting a medical billing company, you don’t need a coding certification but it certainly helps to understand how medical coding works.
In the beginning, I went to Clark University for medical billing and coding. I had a very strong knowledge of medical terminology, anatomy, and coding when I graduated. I did not get certified after I finished. I had researched medical billing businesses and found out how lucrative they could be. I went on to start a medical billing company and became a certified reimbursement specialist.
There were three factors that made me take this direction:
- I wanted to be a business owner
- I wanted to work from home
- I wanted to make a lot of money
- I wanted to support my children on my own
Think about what you want, are you ready to start a business of your own? Do you want the freedom of making your own work hours? You can visit me at www.jennifergomm.com if starting a medical billing business is the right path for you.
Job Duties of a Medical Coder
A medical coder analyzes the documentation of services with a healthcare provider (physician, nurse, chiropractor etc.) and determines the appropriate procedure code (CPT- Current Procedural Terminology) or HCPCS (Healthcare Common Procedure Coding System) to match the services provided. They also use the diagnosis code (ICD10 International Classification of Disease) that has been documented by the healthcare provider.
Because of the extreme importance placed on accurate coding, medical coders must often coordinate with other members of the staff to get more details about a particular patient.
Choosing an incorrect code could result in a loss of income for health care provider. In a large professional setting where the two professions are separate, medical coders are more concerned with compliance to universal meanings of codes.
Often, a medical coder works freelance, in a facility, or a physician’s office and are paid an hourly salary. This makes it more difficult to go into business for themselves and make a lot of money.
Job Duties of a Medical Biller
A medical biller takes the assigned codes that the coder or healthcare provider chooses and enters them into billing software and submits them to the insurance company or appropriate payer to be paid.
They follow up and complete the whole revenue cycle process (post payments, appeal denials, and bills patients) and ensures it is completed.
The biller also has daily interactions with insurance companies and patients to make sure the claims are paid correctly and timely.
Eligibility verification is another big part of the biller’s job. Incorrect eligibility can lead to unhappy patients and lost revenue.
They have direct communication with patients and healthcare providers about understanding their payment obligations. These might include copays, coinsurance, and deductibles. As stated above, in a properly run office this is done before they are seen.
They are responsible for choosing the correct billing format, payer id’s, addresses, modifiers, and any required documentation. Most of their efforts are spent making codes conform to specific payer requirements to describe medically necessary services for reimbursement purposes.
Lastly, medical billers are not allowed to choose the CPT code. This violates ethical practices as they might pick higher paying codes.
How Are Their Jobs Similar?
Both medical billing and coding share some similarities. They both work in the healthcare setting. They do share some duties such as collecting documentation, collecting accurate facility and patient information. Both jobs are absolutely crucial to the cash flow of facilities and physician offices. It is also helpful for both to have a knowledge of how it all works to aid one another. The U.S. Bureau of Labor Statistics classifies medical billers and medical coders as Medical Records and Health Information Technicians.
No matter the differences in the job duties, both billers and coders must be detail oriented, use correct coding, and stay compliant with the current government regulations. They need to have good communication skills as they deal with patients, doctors, and all other related staff. They need to have computer knowledge, as most of the software today is on a computer, cloud or server based. Lastly, both need to possess integrity, and the law requires the PHI (protected health information) follow HIPAA guidelines.
If after reading this, you are interested in starting your own medical billing business please visit me at www.jennifergomm.com. I offer one-one business coaching and a monthly membership to assist you in your billing business startup.