{"id":5564,"date":"2019-03-22T09:30:33","date_gmt":"2019-03-22T13:30:33","guid":{"rendered":"https:\/\/www.goodwin.edu\/enews\/?p=5564"},"modified":"2024-12-19T17:14:01","modified_gmt":"2024-12-19T22:14:01","slug":"what-is-medical-billing-and-coding","status":"publish","type":"post","link":"https:\/\/www.goodwin.edu\/enews\/what-is-medical-billing-and-coding\/","title":{"rendered":"What is Medical Billing and Coding?"},"content":{"rendered":"

Medical Billing and Coding is an essential and emerging area of the healthcare field. Its key role is to streamline the reimbursement cycle of the healthcare system, ensuring that medical providers (such as physicians) are paid for the services they perform. Medical billing and coding are actually separate, yet closely-related practices that are often combined into one profession: the Medical Biller and Coder. To help you gain a better understanding of the field at large, we\u2019ll start by defining the two separately.<\/p>\n

Medical coding<\/strong>, also called medical classification, is a lot like translation. This practice involves converting health information and patient data \u2013 the diagnosis, procedures, medical services, equipment used \u2013 into a universal, medical, alphanumeric code. Data is gathered from patient records, physician\u2019s notes, lab results, and other documentation, then later transformed into a code that insurance companies can clearly interpret and understand. For every diagnosis and medical procedure, there is a corresponding medical code.<\/p>\n

This means there are thousands of medical codes out there, each matching with a different procedure or service, illness or injury. There are specific codes for the type of visit (inpatient, outpatient, etc.), the symptoms that a patient is showing, the tests that are performed, and the diagnoses decided upon. These codes act as the universal language between clinicians, medical facilities, insurance companies, government agencies, and other health-related organizations. They are created using specific coding classification systems, such as\u00a0CPT\u00ae<\/sup><\/a>,\u00a0ICD-10-CM<\/a>, and\u00a0HCPCS Level II<\/a>.<\/p>\n

Once codes are determined and confirmed for accuracy (by a Medical Coder, or Medical Biller and Coder), they are entered into a system and passed onto the Medical Biller. It is these codes that help healthcare providers bill accurately, and turn a profit efficiently.<\/p>\n

Medical billing <\/strong>is a lot like its name implies. It involves taking the medical codes and creating a bill for health insurance companies, commonly known as an insurance claim. Medical billing is the process of submitting these claims to patients\u2019 insurance companies, so that a healthcare provider can get compensated for the services rendered. Medical Billers are also responsible for following up on insurance claims, to ensure the reimbursement is granted. Medical billing is an important facet of the healthcare facility, in that it safeguards and optimizes revenue.<\/p>\n

Sometimes, health insurance companies are not involved in this reimbursement process, and a Medical Biller will invoice a patient for the services received. Healthcare facilities must bill in order to pay their providers, as well as to continue offering their services and maintaining clean, up-to-date equipment.<\/p>\n

As you can see, Medical Billing and Medical Coding are unique entities. However, they are integrated in that the common goal is reimburse healthcare providers for patient services. While it may seem like going to the doctor for an appointment is a simple, 1-to-1 encounter, it actually involves a variety of different parties and processes to get that appointment paid for. That\u2019s where the Medical Biller and Coder comes into play.<\/p>\n

What does a Medical Biller and Coder do?<\/em><\/strong><\/p>\n

A Medical Biller and Coder is responsible for taking health information, and further converting it into codes that allow the provider to receive reimbursement from health insurance companies. Usually, this person is the main entity in interpreting and coding patient data, entering it into the system, and then submitting the codes and claims to insurance companies. The Medical Biller and Coder is often one person; however, this role can also be conquered by two separate professionals, one Coder and one Biller, that work together to ensure invoices are properly paid.<\/p>\n

On the medical coding side of things, the professional would be responsible for reviewing clinical statements, patient records, transcribed notes from the physician, and lab or radiology results, and assigning standard medical codes to each service or diagnosis, using a classification system.<\/p>\n

On the billing side of the job description, a Medical Biller would then translate the code into medical claims, to send to insurance companies or other payers like Medicare in a timely manner. This person will then follow the claim, to ensure the provider receives proper\u00a0reimbursement<\/a>\u00a0for the work performed.<\/p>\n

A Medical Biller and Coder can generally be found:<\/p>\n