So you may have heard the terms medical biller and medical coder and think they are one in the same job. Although they both have to do with the revenue cycle of medical billing, there are some differences between the two. A medical coder interprets doctor's visits along with clinical documentation and translates this into diagnosis and procedural codes also known as ICD 10 and CPT codes.
When a doctor sees a patient, they document what their findings were and what was done during the visit. The Medical coder takes all of the doctor's documentation and interprets the documents into codes that coincide with the appointment. Once the medical coder completes the coding, this information is passed to the medical biller who takes those codes and formulates them into a medical claim to be sent and processed by the patient's insurance company.
The Medical Coder and Medical biller may be two different people or it could be the person doing both jobs. Both are essential to the success of any medical facility or practice, and the two need to work together to make sure the billing is accurate and revenue is coming in. Because this site focuses more on Medical Billing, let's first go into more detail of what it is a medical biller does.
Medical billers work closer with insurance companies and patients in making sure the doctor is paid for their service. When a medical coder has completed their portion of assigning codes for the doctor's procedures and treatments, a superbill is created and passed on to the medical biller who creates a patient encounter and inputs the information into a billing software system, checks the patient's insurance by verifying their eligibility and benefits, submit for any authorizations or pre-certifications, enters diagnosis codes, procedure codes, and modifiers, and into the billing software and creating a claim making sure it follows all guidelines and submitting that claim to the patient's insurance company for payment.
Once the claim is submitted to the insurance company, the medical biller tracks the claim to make sure payment is received. It can take 14-30 days to receive payment, but it is the medical biller's job to make sure this happens. If no payment is received the medical biller contacts the insurance company to see why there is no payment. There can be many reasons why the claim was not paid and that is where the medical biller will begin to take additional measures to make sure the claim gets paid. Once the claim has been paid Medical billers make sure they post payments to the claim it applies to and the claim or send the patient a bill for their portion of the amount owed, and once the patient has paid what they are responsible for (copay or deductible) the patient's account is complete.
Medical coders work mainly with the doctor or nurses and must gather all patient information such as medical records and clinical documents to interpret the patient's procedures and treatments provided by the doctor and assign it into precise codes. They also have to work closely with the medical biller to make sure that the codes they assign coincide with the procedure codes for a compliant and accurate claim.
Medical coders have to understand medical terminology and anatomy so they can apply the codes accurately based on the information documented by the doctor. Medical coders may use coding books or electronic tools to help them code accurately so that the claim is justifiable in proving medical necessity, compliant with insurance guidelines, and clean or error-free for processing.
So as you can see both of these roles are essential in healthcare and are equally important and the goal for both is the same, but their processes and job duties are different. Which one do you think is the best job for you?
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