What Is Medical Coding And Billing

What does a medical coder and biller do?

What Is Medical Coding And BillingMedical coding and medical billing play two separate job roles, but in some organizations medical coding and billing is performed by the same person or it can be performed by a separate person or department. Medical coding provides the key step in the medical billing process.

Medical coder does:

Every time a patient receives professional health care in a hospital, clinic, physician’s office, etc., the physician or the provider must document the service provided for that patient.  The medical coder (you) will review and assign the appropriate numeric and alphanumeric codes to the report. These codes provide a brief version of the lengthy description for illnesses, disease, and treatments rendered to that patient.

There are two types of Medical coders:

  • Outpatient coders focus on coding the records of patients who are seen in physician offices or who are admitted to areas of a hospital that provide outpatient services (emergency rooms, same day surgery, hospital clinics, etc.).
  • Inpatient coders are responsible for coding the more complex records of those admitted to the hospital as inpatients.

Medical biller does:

A medical biller utilizes the numeric and alphanumeric codes provided by the medical coder and then will use it to complete and submit claim forms to the insurance companies or to a patient to get those claims paid.

Medical coders and medical billers can work in a billing office, from home, medical practice, skilled nursing facility, hospital, etc.

Is medical coding the same as medical billing?

No, medical coding and medical billing are two separate functions and do not perform the same tasks, but you need both to carry out the entire process. You can get trained to be a medical coder or medical biller or you can get trained to do both jobs. A medical coder is responsible for assigning numeric and alphanumeric codes (CPT codes, ICD-9 codes and HCPCS codes) to the diagnoses and procedures found in a patient’s medical record before a medical biller can bill these claims to an insurance company or patient for reimbursement. Although they are separate functions, medical coding and medical billing work together in order to ensure that health care providers are reimbursed for their services.

Is medical coding and billing a good career choice for me?

As a medical coder you need to work well with numbers and have the ability to pay close attention to detail when working on coding a report. As a medical biller you need to have a highly skilled customer service attitude as you need to deal a lot with people. As a medical coder and biller you have to be able to work without being supervised, enjoy working hours in front of a computer, and have an understand of healthcare.

You should also ask yourself these questions:

  • Are ready to take a training class to gain the knowledge for medical coding and/or medical billing?
  • Do you have the focus required to handle detailed procedures and process them?
  • Are you interested in learning about the body and healthcare?

If you answer yes to all these questions then medical coding and/or billing is a good career choice for you.


What skills are needed in medical coding and billing?

Medical coder skills:

A medical coder must have the task of working well with numbers and be detailed oriented. You will also be doing other tasks such as processing, reviewing, and submitting claims. There may be times when additional information is needed from physicians or other medical providers and you will need to contact insurance companies regarding questions about claims; so good communication skills will come in handy. One important tool that you will constantly be working with is the computer and various types of medical coding and billing software programs.

Medical biller skills:

A medical biller requires good customer service skills as you will work with a variety of people in order to get the proper payment for the physician or hospital you are employed with. Furthermore, professional service will be needed because you will constantly be calling insurance companies, physicians, patients, etc. where as in medical coding you will not interact as much with patients.

Both medical coders and billers must:

  • Have an understand of basic medical terminology
  • Have a basic knowledge of anatomy and physiology
  • Have knowledge of diagnosis and procedures coding
  • Have critical reading and comprehension skills
  • Have basic math skills
  • Work independently
  • Basic computer skills needed to enter data onto insurance claims  electronically
  • Have strong oral and written communication skills
  • Be detailed oriented / Pay attention to detail
  • Be able to think critically
  • Have high ethical standards.