What Do Medical Coders Differ From Medical Billers?

What do medical coders differ from medical billers?  

Doctors and healthcare providers don’t take down payments from the patients they have treated. An integrated process that involves calculating the cost of the healthcare service according to the disease of the patient and then sending an invoice to the insurance company for reimbursement is utilized for medical bill payments. Hospitals and healthcare organizations rifle through a huge list of medical billing companies because medical billers help the hospital obtain revenue. The billers follow up with the insurance company with a strong claim so that the insurance company cannot back out, whether it is a Government company or a private company. The billing service includes actions performed by a specialized vendor, procedural codes that apply the correct payment codes for the disease that has been diagnosed and serviced, coders that are responsible for diagnosis codes, and a team full of medical billers.

What is included in the medical billing process?

  1. It is the process of following up with insurance companies for reimbursement of healthcare services without letting the insurance company backing out from making payments.
  2. They also convert the healthcare procedure into a billing service.
  3. Medical billers ensure that the work that is completed by doctors, nurses, gynaecologists, paediatricians, and orthopaedists obtain remuneration for their services.
  4. Many insurance companies utilize futile excuses to back out of fulfilling claims so that they don’t have to give any money. However, hospitals and health care providers employ top medical billing companies who set the hospital rates such that all damages and losses are taken care of.
  5. When some part of the bill is paid by the insurance company and the remainder is paid by the patient, the process is called co-paying.

What is included in the medical coding process?

  1. Medical coding is basically used to obtain the universal medical alphanumeric codes that represent every healthcare diagnosis, medical service, surgery, procedure, and equipment.
  2. The diagnosis and procedure codes are present in the medical record documentation which includes the transcripts of the notes made by the physician, radiologic results, and laboratory results which are used for medical coding.
  3. It is the job of the medical coder to ensure that the codes are applied to the correct patient’s disease in the bills. This is done by extracting information from documentation, assigning the codes, and creating a claim that will be presented to the insurance providers.

How do the two differ?

  1. Conduction of audits and refiling of denied claims is the job of a medical coder. Coders also teach the doctors and healthcare providers about the correct codes which comply with the federal mandates.
    The medical biller does the job of collecting information for the billing process and this information consists of charge entry, payment posting, claims transmission, insurance follow-up and patient follow-up. They also build a strong case for insurers by collecting extra information from doctors regarding the diagnosis.
  2. The coder verifies all the services provided to the patient by examining the patient records. The coder and biller make a claim that cannot be denied.