Medical Billing Vs Medical Coding - What's the Difference?

by Svast Healthcare Medical billing

Medical billing is an essential payment process within the United States healthcare system. The process involves a health care provider submitting claims for services rendered to the insured, following up with healthcare insurance companies so as to obtain payment for medical services rendered; including diagnostic tests, procedures, and treatments. The claims process is usually managed by a claims specialist who has received specialized training in medical billing and coding.

Medical billing and coding outsourcing are a preferred choice of many providers because it allows them to seamlessly integrate all areas of the business, from claims and reimbursement to procurement and auditing. Medical billing outsourcing enables service providers to quickly and easily submit claims to different healthcare insurers. Some claim specialists also perform revenue cycle management tasks that include scheduling of patients, maintaining patient records, and analyzing billing information.

While an in-house health insurance billing and coding specialist typically provide medical billers and coders with comprehensive training in the medical billing and coding process, there are instances where he or she may not be familiar with specific areas. If this occurs, the provider can rely on an outside service provider who is well-versed in all areas of the healthcare industry to submit claims and/or code bills according to state laws, regulations, codes, policies, and reimbursement options. A medical biller or coder can communicate with the health insurance company and health insurer's claims adjuster effectively and efficiently through electronic communication, allowing both parties to meet their legal obligations.

A professional Medical billing and coding coder will generally have strong IT skills and expertise in a wide variety of computer software programs and hardware, as well as familiarity with payroll systems, accounting procedures, health insurance forms, health care providers' software, health care insurance forms, patient education, reimbursement processing, insurance claims processing, and billing. An on-site medical coder can also assist with administrative tasks such as filing insurance forms, assisting in the preparation of medical documents, and answering phone calls and emails. An in-house coder will typically have completed the necessary courses and will be able to perform routine administrative tasks such as scheduling appointments, receiving and entering information on patients, submitting medical diagnosis codes, filing insurance claims, sending billing and claim requests to health insurers and health plans, and handling routine correspondence from patients and health insurance companies.

It is important for health care providers to understand the differences between medical billing and medical coding. Medical billing usually refers to the process by which health care providers submit claims to insurance companies for payment. Medical coding, on the other hand, refers to the method of assigning codes to various medical diagnoses and procedures so that these can be used by a doctor, nurse, or other medical professional for billing. In order to accurately assign appropriate codes to different medical diagnoses and procedures, a qualified professional must be properly trained. Medical billing usually involves more paper-based processes than does medical coding.

Both processes involve the use of current procedural terminology (CPT) codes. Health care providers should check with their health plan administrator to ensure they are correctly using CPT codes when they file claims. Medical billing and coding professionals are certified in CPT and HIPAA codes. They are required to take a comprehensive training course in both coding and billing before working professionally.

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Created on Mar 1st 2021 02:33. Viewed 69 times.


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