Are you considering a career in medical billing or coding? Whether you’re a healthcare professional, a facility owner, or someone looking to enter the healthcare industry, it’s crucial to understand the differences and similarities between these two essential roles. In this blog post, we will dive into the world of “medical billing vs medical coding”, comparing their responsibilities, education, and training requirements, and how they contribute to healthcare revenue cycle management.
Key Takeaways
- Medical billing and coding are distinct functions in the healthcare industry, with unique job duties, skills & educational requirements.
- Healthcare Revenue Cycle Management is optimized through accurate medical billing & coding using standardized codes.
- Medical billers and coders have a positive job outlook with competitive salaries ranging from $35K to $64K per year.
Understanding Medical Billing and Medical Coding
Medical billing and coding are integral components of the healthcare industry, ensuring the smooth flow of financial transactions between healthcare providers, insurance companies, and patients. Both medical billers and coders work together to maintain an efficient healthcare revenue cycle, enabling medical facilities to receive payment for services rendered.
Despite their interconnected roles, medical billing and coding are distinct professions, each with its specific responsibilities and skill sets.
Medical Billing Definition
Medical billing is the process of:
- Submitting and following up on insurance claims with health insurance companies to receive payment for services rendered in the healthcare setting
- Initiating the claims process by drafting and sending bills to payers
- Tracking payments
- Following up on unpaid claims
- Resolving issues
- Appealing denied claims
These are all tasks performed by medical billers.
For medical billers to thrive, they generally require an associate’s degree or certificate from an accredited training program, and they might consider professional certification like the Certified Professional Biller (CPB) or Certified Coding Specialist (CCS).
Medical Coding Definition
Medical coding, on the other hand, involves the assignment of standardized codes to medical diagnoses, procedures, and services for billing, record-keeping, and research purposes. Medical coders review patient medical records and clinical documentation to accurately identify and assign the relevant medical codes, such as the American Medical Association’s Current Procedural Terminology (CPT) and the International Classification of Diseases, Tenth Revision (ICD-10) by the World Health Organization.
For professional success in medical coding, obtaining accreditation via an approved certification exam, such as the Certified Coding Associate (CCA) exam by the American Health Information Management Association or the Certified Professional Coder (CPC) exam by the American Academy of Expert Coders, is necessary.
The Roles of Medical Billers and Coders
Medical billers and coders perform complementary roles in the healthcare revenue cycle. Medical billers primarily submit claims and secure accurate reimbursement from insurance companies, while medical coders are responsible for the assignment of appropriate codes to medical services and procedures, ensuring the accuracy and completeness of medical records.
Both healthcare professionals and healthcare providers are essential in maintaining the healthcare revenue cycle and ensuring the financial stability of healthcare providers.
Responsibilities of a Medical Biller
A medical biller’s primary responsibilities include creating and submitting claims, verifying insurance coverage, tracking payments, and resolving billing issues. The claims process starts with patient registration, insurance verification, and documentation of notes during the patient encounter. Then, using the superbill or medical coding information, medical billers prepare the claim, ensure it’s formatted correctly, submit it to the insurance company, and follow up accordingly.
Excellent communication skills, problem-solving aptitude, and familiarity with medical terminology are vital for success in this role.
Responsibilities of a Medical Coder
Medical coders are responsible for reviewing medical records, assigning accurate codes to diagnoses and procedures, and ensuring adherence to coding standards and regulations. They convert complex medical information into alphanumeric codes, which facilitate patient communication, billing, and reimbursement from payers. Attention to detail and organizational capabilities are imperative for success as a medical coder.
Moreover, medical coders are integral in verifying insurance coverage and confirming the appropriate billing of provided services.
Differences Between Medical Billing and Medical Coding
Although medical billing and coding professionals work together to maintain an efficient healthcare revenue cycle, their roles differ significantly. Medical billing focuses on submitting and tracking claims with health insurance companies to receive payment for healthcare services provided, whereas medical coding involves assigning standardized codes to medical diagnoses, procedures, and services for billing, record-keeping, and research purposes.
A detailed examination of their job duties, skills, and educational requirements will highlight these differences further.
Job Duties and Skills
Medical billing and coding have distinct job duties and skills, with billers concentrating on the financial aspects of healthcare and coders focusing on the precise representation of medical services through codes. Medical billers are responsible for submitting claims, verifying insurance coverage, tracking payments, and resolving billing issues, while medical coders review medical records, assign relevant codes to diagnoses and procedures, and guarantee adherence to coding standards and regulations.
Medical coders must be detail-oriented and organized, while medical billers need excellent communication skills and problem-solving aptitude.
Education and Training
Education and training for medical billing and coding careers may include associate degrees, certification programs, and on-the-job training, with certifications from organizations like the American Health Information Management Association (AHIMA) and the American Academy of Professional Coders (AAPC). While both professions typically require a postsecondary degree or an associate degree in coding/billing or health information technology, medical coders must obtain certification by passing an approved certification exam, such as the AHIMA’s Certified Coding Associate (CCA) exam or the AAPC’s Certified Professional Coder (CPC) exam.
Similarities Between Medical Billing and Medical Coding
Despite their differences, medical billing and coding share several similarities. Both professions are essential components of healthcare revenue cycle management, working together to optimize reimbursement and maintain financial stability for healthcare providers. Additionally, both medical billers and coders use standardized coding systems, such as ICD-10, CPT, and HCPCS, to facilitate accurate billing and record-keeping.
Healthcare Revenue Cycle Management
Both medical billing and coding are essential components of healthcare revenue cycle management, working together to optimize reimbursement and maintain financial stability for healthcare providers. Medical billers prepare and submit billing claims to insurance carriers, while medical coders guarantee the accuracy and completeness of the claims by assigning the relevant codes.
Their collective efforts facilitate the smooth functioning of the healthcare revenue cycle by helping healthcare providers receive the due reimbursement for their services.
Use of Standardized Codes
Medical billers and coders both utilize standardized coding systems, such as ICD-10, CPT, and HCPCS, to facilitate accurate billing and record-keeping. The International Classification of Diseases (ICD) and the Healthcare Common Procedure Coding System (HCPCS) are the standardized procedure codes used in medical billing and coding.
These standardized codes provide a shared language that allows healthcare providers, insurance companies, and government agencies to communicate and comprehend medical procedures, diagnoses, and treatments, streamlining billing and coding procedures, decreasing errors, and enhancing reimbursement accuracy.
Career Opportunities and Salaries in Medical Billing and Coding
Medical billing and coding professionals are in high demand and can expect to earn a competitive salary. Opportunities are available in:
- Hospitals
- Clinics
- Insurance companies
- Other healthcare settings
The demand for medical billers and coders is expected to grow as the healthcare industry continues to expand, providing more opportunities for professionals with the right skills and qualifications.
Job Outlook
The demand for medical billers and coders is anticipated to increase as the healthcare industry continues to develop, with prospects available in hospitals, clinics, insurance companies, and other healthcare settings. The projected growth rate for medical billing and coding jobs in the upcoming decade is estimated to be 8-11%.
Advancements in health information technology have a positive impact on the job outlook for medical billers and coders, with the U.S. Department of Labor predicting that employment for health information technicians will grow by up to 15 percent through 2024.
Average Salaries
Salaries for medical billing and coding professionals vary based on factors such as:
- Experience
- Education
- Certification
- Location
The average salaries range from $35,000 to $55,000 per year. The average entry-level salary for medical billers in the United States is $42,297 per year, while the average salary for medical billers with 5-10 years of experience is $47,180 annually.
Medical coders can expect an average entry-level salary of $43,900 per annum, with those having 5-10 years of experience earning an average of $64,655 per year.
Outsourcing Medical Billing and Coding Services
Outsourcing medical billing and coding services can be a viable option for healthcare providers seeking to optimize their revenue cycle and allocate resources more efficiently. Engaging an external company to oversee the billing and coding operations allows healthcare providers to focus on their core competencies of delivering quality patient care while ensuring accurate and timely reimbursement for services rendered.
There are potential benefits and drawbacks of outsourcing medical billing and coding services. Benefits may include revenue optimization and resource allocation, while potential drawbacks could involve a lack of control over resources, variable costs, and potential loss of invested time and money on billing technology and training. In considering outsourcing, you should weigh these factors and opt for a reputable vendor capable of providing cost-effective, high-quality services aligning with your healthcare facility’s needs and goals.
Summary
In conclusion, medical billing and coding are essential components of the healthcare industry, each with unique roles, responsibilities, and skills. Both professions contribute to the efficient functioning of healthcare revenue cycle management, ensuring accurate and timely reimbursement for services rendered. Whether you’re considering a career in medical billing or coding, or you’re a healthcare professional seeking to optimize your facility’s operations, understanding the differences and similarities between these two vital roles can help you make informed decisions and contribute to the overall success of the healthcare industry.
Frequently Asked Questions
Overall, medical coding specialists tend to earn a higher salary than medical billers, so it is generally better to be a medical coder.
Becoming a medical biller and coder requires dedication and hard work. It involves analyzing healthcare data and translating it into standardized codes, and it takes education and training to master the skills required. However, with the right preparation and practice, becoming a medical billing and coding professional is far from impossible.
Certified Professional Compliance Officers and Documentation Expert-Outpatient Coders are among the highest-paying medical coding jobs, earning an average of $77,190 and $70,000 respectively. Coding Manager, Hospital Coder, and Coding and Reimbursement Specialist are also high-paying positions with salary ranges between $50,000-$75,000 a year.
Medical billing is the process of submitting and tracking claims to health insurance companies for payment, while medical coding is the assigning of codes to diagnoses, procedures, and services for record-keeping and research.
References:
- CPT® overview and code approval - AMA
- International Statistical Classification of Diseases and Related Health Problems (ICD) - WHO
- CPT® Codes: What Are They, Why Are They Necessary, and How Are They Developed?
- What is HCPCS? - AAPC Resources
- Medical Records Specialists - Occupational Outlook Handbook
- Healthcare Occupations - Occupational Outlook Handbook
- Medical biller salary in United States - Indeed.com
- How Much Do Medical Coder Jobs Pay per Month? - ZipRecruiter