Medical Billing and Medical Coding are two related disciplines . Professionals in each field use similar skills to achieve similar results, but the methods they use and how they pursue their goals is different.
Medical coders translate the patient encounter into current procedural terminology (CPT) codes. Your primary responsibility is to ensure that the medical services provided are accurately coded. Medical billers are responsible for creating a claim, based on the codes that a medical coder provides. They ensure that the medical practice receives the highest possible reimbursement for a claim.
Many medical billers are also medical coders and vice versa . The two skill sets are interspersed, because both professions involve the translation of medical documentation into standardized codes, to communicate medically necessary information. Medical billers focus on providing accurate and timely reimbursement, based on the codes used. Medical coders are less focused on reimbursement issues. Their role is to provide the most complete picture of a medical encounter possible, leaving the money issues to the billers. While both professions strive to adhere to guidelines, statutes, regulations, and contractual obligations to provide accurate information; medical coders generally deal with a greater variety of codes, focusing more on the ideal of coding theory.
Medical billers are more knowledgeable about the requirements of commercial insurers, the codes that can be billed, the rules for submitting claims, and how to prepare a clean claim.A basic training in the reimbursement system in the provision of health services, private and governmental organizations and their requirements, are key to success in the performance of the functions of a medical biller and encoder. Change is an ever-present factor in the healthcare administration industry, as codes are defined and redefined, as their use is clarified and specified, and as reporting requirements adapt to evolving health. technology and medical treatment protocols. Without a foundation in the basics, they are soon lost in the drafting of codes, acronyms and regulations. A professional navigates them all and ensures that medical services are accurately described, based on the medical record, and that covered services are paid for appropriately.