Posted by From Diagnosis to Dollars: Understanding the Roles of Medical Coding and Billing. For most people, medical billing and medical coding are similar in their functions, but in reality, they are different. A naïve person considers them one or the same task but there are some differences between them. Professionals of both of these skills use the same skills to achieve their goals but their methods to achieve the goals are different.
Medical coding and billing are interconnected because both of these professions involve proper documentation and coding processes. Medical coders are responsible for the conversion of documentation into standardized codes, while billers use these codes for efficient billing and reimbursement processes.
Both of these processes need data from healthcare organizations. It involves complex and confusing facts, which need to be properly documented to facilitate the billing process. Capital Health Billing promises to deal with your medical billing and coding tasks making the job easier for you. We provide you the facility to record your patient’s medical data electronically using Electronic Health Recording Services.
What is Medical Coding?
Medical coding is a process through which coders assign unique codes to services provided to the patient. These codes are assigned according to universally accepted standards such as current procedural terminology (CPT) and the International Classification of Diseases, Tenth Revision (ICD-10) these codes help to identify proper cost.
The assigned codes are universally accepted in all healthcare organizations, and the American Medical Association revises them twice a year. For instance, the codes used for treatments offered to improve heart health will be different from the codes used for pain management services as these two are of different scopes and involve different procedures.
When a medical invoice for a patient’s treatment is submitted to the insurance company the payer can check which type of service the patient received along with its cost. Then insurance companies reimburse the healthcare providers according to the patient’s plan of services.
Benefits of Medical Coding
Medical coding has lots of benefits. A few of them are as follows:
- Medical coding ensures proper coding of patient medical history
- It helps to generate accurate bills.
- Risks of claim denials are minimized
- It increases healthcare revenues.
- Medical coding provides the facility to generate a customer-specific report based on customer medical reports.
What is Medical Billing?
Medical billing is a process through which healthcare providers or healthcare organizations receive payments. It involves the process of claims submission to insurance companies or government agencies, tracking the status of claims, and then recording payments. Medical billers prepare claims, generate bills, and then submit them to insurance companies or third parties for payment.
There are two types of medical billing front-end and back-end. Front-end billing is when the patient gets an appointment before receiving any medical service. He provides his insurance details
Benefits of Medical Billing
Medical billing has various benefits for doctors, patients, and the revenue cycle of healthcare organizations. A few of them are as follows.
- Medical billing ensures accurate and timely delivery of payments.
- It also helps to maintain records of payments received by claims.
- It facilitates the claim preparation process. As claim submission for complex treatments like fungal infection will require more documentation than any treatment with no binary procedures.
- A transparent billing process improves patient satisfaction.
Difference between medical coding and Medical Billing
Although both of these fields struggle to achieve similar goals there are some differences between them.
- Medical coding is the translation of patient clinical data into universally accepted codes while medical billing uses these codes to generate bills and prepare claims.
- Medical billing involves communication with insurance companies, government agencies, or any third party that is involved in the payment process. On the other hand medical coders communicate with doctors, nurses, or any other personnel who are responsible for the documentation of patient clinical data.
- Medical coders are responsible for coding all the services patients receive from a minor service like allergy treatments to a major practice like depression recovery. While medical billers are responsible for payment of those services.
How Technology has Improved the Medical Coding and Billing process?
Technology has significantly facilitated different healthcare functions like data collection, billing, timely treatment of patients, etc. The main advantage of technology is that it reduces paperwork, saves time, and ensures accurate documentation of data. There are different ways technology has influenced the healthcare sector. A few of them are discussed below:
1. Electronic health record system to maintain data
Technology allows the maintenance of patients’ clinical data electronically using Electronic Health Record systems (EHRs).EHRs allow integration of medical coding with the documentation process which makes it easy for coders to access patient data to generate codes.
2. Use of coding tools and software
There are several coding tools and software available that help coders write codes efficiently, improve the accuracy of codes, and ensure compliance with coding guidelines. Be it coding and billing for dental procedures like identifying gum diseases or it is about ENT practices, compliance with the guidelines for accurate coding and billing is pivotal.
3. Use of Auditing tools
Auditing tools ensure that healthcare providers are following coding standards and regulations. Moreover, these tools also ensure the accuracy of code and improve the performance of revenue cycle management.
4. Revenue cycle management system (RCM)
It helps to manage the revenue cycle of the healthcare organization efficiently. The revenue cycle starts as soon as the patient first visits the doctor and, ends with full payment of all services provided. RCM is responsible for the management of all the financial activities involved in the revenue cycle. It facilitates the reimbursement process and ensures timely payment of services provided.
Wrapping It Up
To summarize, although medical coding and medical billing struggle to achieve the same goals they are different in some aspects. Medical coding is a process of translating patient clinical documentation into alphanumeric codes while medical billing processes use these codes to prepare and submit claims and receive payments. Both of these processes are crucial for the efficient growth of healthcare organizations.