What Is The Difference Between Cpt And Icd-9 Procedure Codes Difference Between Medical Coding and Billing

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Difference Between Medical Coding and Billing

Often mistaken for the same thing, medical billing and medical coding are two very separate jobs. Although there are many similarities between the two, and small healthcare facilities may assign both tasks to a single person; in most medium and large healthcare facilities, different people are responsible for the two different jobs. Both jobs fall under medical records and health information technicians. In order to understand the differences between medical coding and medical billing, let’s look at the responsibilities of the two job profiles.

Medical Coding

The purpose of medical coding is to assign the appropriate code to the various treatments given to a patient to facilitate insurance claims. Medical coders study a patient’s medical records to determine the procedures performed on the patient by the doctor, surgeon, nurse, and other members of the healthcare team. They check the doctor’s transcripts, laboratory test results and other documents related to the patient’s treatment. If no further detailing or clarification is required, the medical coder assigns the correct diagnosis or procedure code to the appropriate service provided to the patient and creates claims to be paid by the insurance company. Codes are assigned according to the Current Procedural Terminology (CPT) to the procedures received by the patient, and the International Classification of Diseases (ICD) to the diagnosis of the patient by the doctor.

It is extremely important that the medical coder is accurate during the coding process, as insurance companies use this data when processing patient complaints. Medical coders must often interact and coordinate with other health care and staff members to either collect more data related to the patient’s treatment or to inform them of the types of data and information needed in the patient’s medical record to ensure the coding process smooth and efficient operation. .

Medical billing

Medical billing refers to checking the assigned medical codes and forwarding the claim. Using special software developed to enter the codes assigned by the medical coder and other relevant insurance information, the medical biller forwards the insurance claim to facilitate payment. After the insurance claim is forwarded, the medical biller remains in contact with the patient and the insurance company to make sure the claim is paid. In the event of a delayed, denied, or denied claim, the medical biller must contact the patient and the insurance company to resolve the matter and resubmit the claims with the necessary modifications; if required by the insurance company.

Medical billers often have to explain benefits and answer questions about their insurance when they receive insurance information from patients themselves. They are also responsible for clarifying questions about charges on the bill if the patient requests it. The medical biller is required to explain the deductibles, co-pays and co-insurance required by the insurance company in case the patient wants to know why they still have to pay even though they are covered by the insurance. However, medical billers must be familiar with the claims process and know all the requirements that must be submitted in order to process a claim. It is their job to ensure that the correct invoicing format is followed, all questions are answered appropriately and all supporting documents are attached before submitting the claim to the insurance company.

Medical billers must also ensure that insurance companies pay the doctors and the medical facility for services provided to patients.

Common funds

It is important that both medical coders and billers pay close attention to detail and ensure the accuracy of codes and all other insurance information entered into the system. Both jobs require interpersonal skills as they deal with medical staff, patients and insurance representatives. Most importantly, both medical coders and billers must have integrity, as the law requires patient information to be kept confidential.

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