Medical Coding and Medical Billing – A Complete Guide
Medical Billing and Medical Coding

Medical Coding and Medical Billing – A Complete Guide

It is no secret that the healthcare industry is booming and is expected to grow more in near future. With a population of more than 46 million, Americans are anticipated to need various kinds of medical facilities in the coming years. At first glance, you might think doctors and nurses are the ones running any medical institution. That is a fair observation since they are the ones who treat patients. However, apart from the frontline workers, there are many other individuals who help these doctors and nurses make their life easy.

What Is Medical Billing And Medical Coding?

Medical billing and medical coding are the two most critical and important of medical practice. It is utterly important to be very accurate in both these areas since they are extremely important for any patient’s safety. Accurate billing is also necessary for efficient operations and a rapid payment process. Medical billing and coding are two very crucial steps and require extremely skilled professionals. These professionals should be able to read, record, interpret and track every medical information quickly. 

Medical billing is a perpetual function that all hospitals and healthcare institutions follow these days. Medical billing is the process of preparing invoices and submitting them to insurance providers. This ensures that the invoices are reimbursed and the hospital gets the correct amount for the service they have offered. 

Is Medical Coding the Same as Medical Billing?

Healthcare service providers in the US are compensated for delivering medical services including evaluating, diagnosing, and treating patients. Medical billing is the term used for denoting the process of invoicing. It involves the process of healthcare practitioners such as nurses and doctors filling up forms depending on the medical services rendered. These forms are then submitted to insurance companies for receiving payments. 

Medical coding, on the other hand, is the process of converting medical services, diagnosis, equipment, and medical procedures into alphanumeric codes. A clinical coder is a certified professional whose main task is to analyze various medical and clinical statements and assign codes based on a predefined classification system. 

Both medical billing and medical coding play a crucial role in running a healthcare institution. Both of these functions act as the backbone of the revenue cycle and ensures that the healthcare providers are compensated timely for the service offered. Medical billing combined with coding helps in efficiently billing patients.

Significance of Medical Billing

What Is The Significance of Medical Billing?

When someone is sick, visiting a doctor seems to be the only thing that someone has to do. But it is part of a large network that includes other steps like rendering medical services and payments. The entire medical diagnosis treatment can be divided into three parts:

  • The patient
  • Healthcare provider which includes physicians, doctors, nurses and other individuals working in the healthcare organization. 
  • Insurance company

A medical billing and medical coding professional plays a very important role in discussing and arranging proper payment between the three parties. The medical billing professional ensures that the healthcare service provider is paid correctly for the service offered. The biller collects all information regarding the patient and the medical services provided, producing a ‘superbill’ which is then sent to the insurance company in order to process the claim. 

A medical insurance claim contains the below-mentioned information

  • Medical history information of the patient
  • Demographic information of the patient
  • Details about insurance coverage
  • Medical services are taken by the patient

What Do Medical Billers and Coders Do?

Are you interested in starting your career in the healthcare industry but not sure how to get started? Are you looking for office-based jobs rather than taking care of patients? If yes, medical billing and coding are two good options available.

Medical billing and coders are often referred to as health claim specialists. These individuals are primarily responsible for processing various health insurances. They are expected to be highly organized individuals and should be able to pay attention to details. 

Here are some of the typical responsibilities of a medical billing and coding specialists:

  • Using a special coding system in order to diagnose and produce bills.
  • Review medical insurance claims of patients to ensure the coding is done accurately.
  • Follow up with insurance companies in order to collect any late payment.
  • Keep a track of payments to ensure all reimbursement is received on time.
  • Coordinate with other staff members to ensure accuracy.
  • Keep a track of changes and advancements in the medical field.

Common Medical Billing and Coding challenges

The primary task of a medical billing and coding specialist is to maintain the smooth functioning of the medical institution. These professionals play a very crucial role in handling every billing information. However, these professionals have to go through various challenges in order to ensure every claim is reimbursed within the given timeline.

  • Getting used to the medical billing and coding system.
  • Technical updates in medical coding and medical billing.
  • Possible errors while extracting data from various reports.
  • Regular follow-up with third parties (i.e. insurance companies) involved.
  • Renewal of the billing and coding certification.

Medical billing and medical coding is a very job role that ensures that healthcare workers are being paid for services they are providing. It is an important component of the entire healthcare industry and ensures smooth operation of the revenue cycle. Medical billers need to understand various terms and regulations involved in the billing process.

Atom Healthcare is one of the medical billing outsourcing companies in the current market, we aim at making health worker’s life easy and less hectic. Our team of experts ensure that accurate billing is produced and the healthcare workers are paid accurately for the services they have offered.

The role of a medical billing and coding professional is very critical. However, if extensive training is provided, these professionals will help in proper revenue flow for any healthcare institution.

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