What is Medical Billing and Coding

Medical billing and medical coding are both two activities that are extremely important in healthcare. They are closely related, so there is often confusion over where one ends and the other begins. Both practices are involved with important reimbursement cycles. This means they are responsible for ensuring that healthcare providers receive compensation for the services they provide. Because of this it is important to understand what medical coding and medical billing really is.

What is Medical Billing

Medical billing on principle is as simple as it sounds. Medical billers get information from the medical coder and they make a bill. There is more to it though. A medical biller takes the code that the medical coder used to describe the service and diagnosis and prescription. They then use these codes to come up with a bill for the insurance provider, or a claim. The insurance decides how much of the bill they are willing to pay and then they return the evaluated claim to the biller. The biller then uses this evaluated claim to figure out how much the patient owes now that insurance has been deducted.

What is Medical Coding

Medical Coding is the process of reviewing clinical statements and assigning codes to the statements. Coding or medical classification is basically the translation of the medical reports into a code that is recognized in the healthcare industry.

Medical Coders take what the doctor writes down whether it’s a diagnosis or a prescription for a medication, and they translate it into a numeric and alphanumeric code. There is a code for every injury, diagnosis, and medical procedure. So it is safe to say that there are a plethora of codes to be used for all of the different procedures. It is the coders job to translate what happens in the office into a code that can be used by the billers. If the coder doesn’t correctly code an injury or procedure, the client can be incorrectly billed consequently.

Medical Coding and Billing Example

Let’s imagine a patient walks into a doctors office one afternoon and tells the doctor that he is having trouble breathing. The doctor writes down the patient’s symptoms and then after doing tests concludes that the patient has bronchitis. The doctor then prescribes the patient some medicine, and the patient is out of the door and on his way to the pharmacy.

A medical coder is responsible for taking all of the doctor’s notes that he recorded during the patient’s visit, and translating them to codes. Once the coder finishes translating the notes, the medical biller uses these codes to draft a bill or claim. The medical biller then sends the claim to the insurance company. The insurance company reviews the claim and decides how much they will contribute to the bill. They return the bill to the biller with the amount that they will cover. The biller then charges the patient the amount that the insurance company did not cover.