Medical coding and billing are two essential components of the healthcare system that are often used interchangeably. Although these two terms are related, they have different meanings, purposes, and functions. Medical coding and billing are crucial for healthcare providers to maintain accurate patient records and ensure accurate reimbursement for services.
Beginning with the patient’s chief complaint, a doctor will assess the patient’s condition, review the patient’s past, family or social history; review the body’s organ systems with a series of questions, examine the patient, and determine the complexity of the medical decision making based on the presenting problems, diagnostic procedures ordered, and management options which can be as simple as ordering bed rest or as complex as dictating emergency major surgery.
What is medical coding?
Medical coding involves assigning numeric or alphanumeric codes to diagnoses and procedures. The purpose of medical coding is to translate medical documents into a standardized language that can be used for billing, reimbursement, and record-keeping between healthcare providers and institutions.
What is medical billing?
Medical billing refers to the processes by which healthcare providers receive payment for their services, whether from patient balances or claims to insurance companies, Medicare, and Medicaid. It has two categories: Front-end billing tasks where verifying the eligibility of patients and pre-authorization of services from insurance providers. Also co-payment process takes place here. Back-end billing tasks where after the provider visits the patient they generate an itemized claim for reimbursement after receiving the medical codes. In addition to this they also track and record payments received, follow up about unpaid claims, resolve issues, and appeal denied claims.
How Are Medical Coding and Billing Related?
The medical billing process contains several steps that must be followed before submission of a claim – all of which encompass front desk procedures to the actual information within a medical record.
Each step is important in the process, beginning with the initial phone call where a patient makes an appointment for an office visit:
• What is the reason for the visit?
• Does the patient have current insurance information on file?
• Is the patient’s address current?
Besides documenting the patient’s history, exam, and medical decision making, important coding questions must be addressed:
• Did the physician document total time or suggest counseling or coordination of care as more than 50% of the visit?
• Was face to face time in outpatient or inpatient setting indicated?
• If smoking cessation counseling was provided, was time indicated?
• Did the provider treat a problem unrelated to the patient’s annual exam?
• Did the physician record how many times a nebulizer treatment was provided or if a
vaccine that was given was actually paid for by the physician?
• Was there a decision for surgery or was a visit billed for a different reason within a post-op global period?
• Are late effects or manifestation diagnosis codes being indicated?
Even if a provider codes his own work, medical billers and coders must often access records to ensure all services are captured.
Medical billing and medical coding are both aspects of healthcare administration related to a provider’s revenue stream. In the claims process, coding takes place before a bill is sent to insurance providers. Medical billers use the codes assigned by medical coders to prepare and submit claims to health insurance companies. Large healthcare facilities often hire both medical coding and billing specialists also with separate inpatient and outpatient coder. While small scale facilities will have one role for both coding and billing.
Beginning with the patient’s chief complaint, a doctor will assess the patient’s condition, review the patient’s past, family or social history; review the body’s organ systems with a series of questions, examine the patient, and determine the complexity of the medical decision making based on the presenting problems, diagnostic procedures ordered, and management options which can be as simple as ordering bed rest or as complex as dictating emergency major surgery.
What is medical coding?
Medical coding involves assigning numeric or alphanumeric codes to diagnoses and procedures. The purpose of medical coding is to translate medical documents into a standardized language that can be used for billing, reimbursement, and record-keeping between healthcare providers and institutions.
What is medical billing?
Medical billing refers to the processes by which healthcare providers receive payment for their services, whether from patient balances or claims to insurance companies, Medicare, and Medicaid. It has two categories: Front-end billing tasks where verifying the eligibility of patients and pre-authorization of services from insurance providers. Also co-payment process takes place here. Back-end billing tasks where after the provider visits the patient they generate an itemized claim for reimbursement after receiving the medical codes. In addition to this they also track and record payments received, follow up about unpaid claims, resolve issues, and appeal denied claims.
How Are Medical Coding and Billing Related?
The medical billing process contains several steps that must be followed before submission of a claim – all of which encompass front desk procedures to the actual information within a medical record.
Each step is important in the process, beginning with the initial phone call where a patient makes an appointment for an office visit:
• What is the reason for the visit?
• Does the patient have current insurance information on file?
• Is the patient’s address current?
Besides documenting the patient’s history, exam, and medical decision making, important coding questions must be addressed:
• Did the physician document total time or suggest counseling or coordination of care as more than 50% of the visit?
• Was face to face time in outpatient or inpatient setting indicated?
• If smoking cessation counseling was provided, was time indicated?
• Did the provider treat a problem unrelated to the patient’s annual exam?
• Did the physician record how many times a nebulizer treatment was provided or if a
vaccine that was given was actually paid for by the physician?
• Was there a decision for surgery or was a visit billed for a different reason within a post-op global period?
• Are late effects or manifestation diagnosis codes being indicated?
Even if a provider codes his own work, medical billers and coders must often access records to ensure all services are captured.
Medical billing and medical coding are both aspects of healthcare administration related to a provider’s revenue stream. In the claims process, coding takes place before a bill is sent to insurance providers. Medical billers use the codes assigned by medical coders to prepare and submit claims to health insurance companies. Large healthcare facilities often hire both medical coding and billing specialists also with separate inpatient and outpatient coder. While small scale facilities will have one role for both coding and billing.