Medical billing and medical coding play two very similar roles in today’s health care. Both roles are utilized in the reimbursement cycle, which exists so that health care distributors get paid for their services.
Medical coding is like converting one language into another. Medical coders are supposed to translate a written text, such as a medical prescription, into an alphanumeric or numeric code that is easier for other employees and insurance companies to understand. For every condition that a patient may suffer and medical procedure, there is a different code for it. In total, there are thousands of different codes, and it is the medical coder’s job to convert text into code.
For example, a patient will suffer signs of illness and will see a doctor. The patient will first see a nurse who will perform some tests on him or her, as the doctor will inspect the patient and declare what they have, and how they can cure it or treat it.
Each part of the patient’s visit is recorded either by the doctor or professional billing services.
The job of the medical coder is to listen for specific words that the doctor and patient say and translate that information into a code that the billing service can understand quicker and easier. To do this, the medical coder reads the report of the patient’s visit and breaks it all down into a code. What kind of visit the patient has, what his or her symptoms are, what tests are being given, and what the doctors prescribes makes one unique code.
Two parts of each code come from The International Classification of Diseases (ICD) and Current Procedure Terminology (CPT). The first relates to a patient’s injury or disease, while the other refers to procedures that the doctor or hospital has prescribed or performed for the patient. These codes are a language for doctors, hospitals, insurance companies, and other organizations.
The code is then saved in a software application on a computer. Once the coding is finished, the code goes to a medical biller.
To better understand what medical billing is, we refer back to the patient’s visit. The medical biller examines the code created by the medical coder, and with the code provided; a claim is created from the software application that the biller uses. The medical biller then gives the claim to the insurance company to examine it, and then will give it back to the appropriate professional billing services. The medical biller then examines the claim and determines what percentage of it the patient owes, once insurance fees are applied.
If patients are medically insured to cover their visit and the procedures to cure the diagnosed condition or conditions, their medical bills will tend to be low. The medical biller looks at the patient’s insurance information to create a bill for them. An itemized bill can also be created to help the patient understand each service that needs to be paid for and how much. If one isn’t created for a patient, then a patient has the right to request one.
If the patient cannot pay his or her medical bills, then the medical biller can proceed to hire a collections agency as an alternative so that patient can compensate the medical provider.
The medical biller acts as a network between patients, insurance companies, and medical providers. Whereas the medical coder translates reports into codes, the medical biller translates codes into billing reports. Without both of these staff members, the billing process would take hospitals weeks or even months to determine what each patient must pay for services.