Medical Billing, Medical Coding

# The Intersection of Medical Billing and Coding: What Providers Need to Know

- May 28, 2024
- Posted by Kristen Edwards

28 May

In the healthcare world, medical billing and coding are often confused together. The general public often thinks of them as the same. However, billing and coding professionals are entirely different. Thus, providers and healthcare facilities should know the differences between them. They should also know the definitions and practical applications of the two concepts. Today, we are going to take a look at the descriptions of medical billing and coding. This article will help providers maintain a healthy revenue generation cycle.

## What is Medical Coding?

healthcarecareercollege.edu

Medical coding means assigning specific codes and numbers to medical procedures, diagnoses, and treatment services provided to patients. Coding translates medical information into a standardized language used to keep a record of the services provided by the hospital. These codes are then used to deposit medical bills, provide invoices, and get reimbursements from insurance companies.

But why do these standardized languages exist in the first place? They exist mainly to maintain a smooth and streamlined treatment and billing process. Hospitals deal with hundreds of patients daily. Each of these patients presents with a disease that needs to be addressed specifically for the symptoms shown by the patient. This can be an extensive process, especially when the hospital has to maintain a proper patient medical record.

This is where coding languages come into action. With the help of codes, we only have to mention the exact numbers. The hospital, billing authorities, and insurance companies instantly become aware of the service they have provided to the patient. The hospital’s finance department also becomes aware of these services, and they can then make a complete document to be sent to the insurance companies for reimbursement.

### What does a medical coder do?

A medical coder does a lot of reading, analysis of data and compilation, and reporting of this data to the relevant authorities. The coder visits each patient or reviews his data via the hospital record, and assigns specific codes to the services provided by the hospital. He also reviews the medical records and histories of the patient and keeps track of any new tests or reports done. He then uses this data and assigns specific codes to the services provided. These codes are then used to get reimbursements from the insurance companies.

A certified professional is also aware of the services being provided which come under the coding guidelines. A coder also stays up-to-date about the government guidelines about the latest codes and modifiers. He is also aware of any other technological advancements being made in the field and uses this information to make the coding system streamlined and in compliance with the latest guidelines.

## What is Medical Billing?

prnewswire.com

Medical billing is the process by which healthcare facilities receive payments for the services they provide to patients. Patients can provide these payments themselves, but the hospital can also get them from medical insurance companies. The billing process usually starts after the coding process. This process uses the data from the coding documents to provide reimbursements to healthcare facilities. Thus, the two processes are very related.

There are two main categories of medical billing: front-end and back-end billing. Front-end billing occurs before the doctor makes any checkup of the patient. It includes verifying the patient data once they have made an appointment. Front-end billers also check the insurance coverage of the patient regarding the services.

Back-end billing occurs after the doctor has performed the patient’s checkup. Once the doctor has made an appropriate diagnosis and treatment plans for the patient, medical coders assign codes. Once this has been done, medical billers use these codes to get reimbursements from insurance companies. This step is very important for generating revenue for the hospital.

The main goal of the billing process is for the hospital to get adequate payments. Medical billers follow the claim application till its completion. They are also responsible for any follow-ups on the claims rejected by the insurance companies. Thus, they create a positive billing environment and a healthy revenue generation cycle.

### Responsibilities of a medical biller

A medical biller maintains a link between the healthcare facility, the patient, and their insurance providers. Billers use the data from medical codes to identify hospital services. They make claim applications and deliver them to insurance companies. They are also responsible for checking for errors in the applications. This prevents claim rejections based on erroneous codes and modifiers. It also ensures that the healthcare provider gets timely reimbursements.

Medical billers also send patients invoices for any outstanding bills. They are responsible for answering any questions the patients might have and keeping the patients in the loop about the whole process. Thus, the billers must have adequate knowledge about the billing process. They should also know the latest changes being made in the field. This allows them to navigate the whole billing process smoothly.

## The Intersection of Medical Billing and Coding

techniblogic.com

Medical billing and coding descriptions are two different concepts. So much so that there are separate departments for the two different jobs. But they are two sides of the same coin. Both work together to ensure that the patients are getting adequate treatment. They also make sure that healthcare providers receive proper payments for their services.

First, the billing department checks the patient’s insurance status to ensure that the services are covered by the insurance company. Then, the hospital performs the appropriate checkup, diagnosis, and treatment. The coding department assigns specific codes to the services. The billing department uses these codes to prepare the claim files. This department also checks for any errors in the claim application.

The billing department also checks the application has proper medical billing and coding descriptions. The billing department then sends the claims files to the insurance companies, which reimburse the healthcare facility based on these applications.

## Conclusion

Thus, we can see that the medical coding and billing departments intersect. They both exist to provide a smooth and streamlined health provision system. They are also responsible for providing proper claim reimbursement and working to set shining standardized medical billing and coding examples.

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