MEDICAL BILLING VS MEDICAL CODING : What is the difference and what do billers and coders do?

Are you confused on the difference between medical billing and medical coding and are you confused why they call it medical billing and coding are they the same thing or are they different well hold on because i'm going to explain to you the differences between medical billing and medical.

Coding hey everyone i'm victoria from contempo coding i am a medical coder auditor educator content creator and on my channel i provide tips tricks and tutorials to help you be successful in a medical coding career i've been asked to explain the.

Difference between medical billing and medical coding a lot of educational institutions now have programs called medical billing and coding but they are two different components within the revenue cycle medical billing is the process of submitting and then following.

Up on health insurance claims making sure they get paid and checking in on those denials a lot of certified medical coders actually wind up starting out in medical billing because it's easier to get your foot in the door somewhere in the revenue cycle and usually that's in the billing department.

So billers have to know all those different insurance policies the appeal process they need to know about timely filing so for example certain insurances say that you have 30 days 60 days 90 days 365 days after that patient has been seen and had that service to submit the following bill insurances.

Also have policies then on if you get a denial how many days after that denial you can submit an appeal so billers need to know those denial codes what those policies are when they can write things off how to sometimes even apply insurance payments and just generally making sure that everything is appropriately applied.

And that we're seeking all of those reimbursements that the healthcare organization or that provider is entitled to so the medical biller works off all the information that's submitted on the cms 1500 or the ub-04 form this is what gets submitted to the insurance company for reimbursement and.

It includes things like the patient's name their date of birth their insurance policy numbers who rendered the service what services were rendered any modifiers cpt icd codes that go on there and then of course how much we're charging the insurance company.

Now hopefully we submitted a clean claim and this will just get paid by the insurance company which will make the biller's life a lot easier they just apply the payment and then adjust off the difference between what we charge versus what the insurance paid now if the insurance didn't pay the full amount or they didn't pay anything maybe.

They send it out as a denial then it's the biller's responsibility to piece together the puzzle of what happened here and how do we get our payment according to the most recent aapc salary survey the average salary for a medical biller is about 55 000 a year now.

Remember that is not starting wages that is average so that might be people who have five years experience ten years experience 25 years experience in billing all average together medical billers also work with insurance portals or they actually call up the insurance and talk to them.

About all of the denials that they're working on and sometimes medical billers will work with patients explaining to them why their insurance claim may or may not have been paid a medical coder is someone who translates medical reports into codes based off of the diagnosis of the patient.

What services were rendered and then any equipment or medications that may have been provided that's not to say that medical coders don't have any part in the billing process sometimes if that biller gets a denial and it says that maybe the codes weren't correct on it maybe they didn't match up.

Or a modifier wasn't applied correctly they might send it back to the coder to have the coder take another look at it and determine if there was something else in the medical record that would help get that paid so medical coders deal a lot more with medical records with documentation requirements with a little bit of.

Compliance they have to know medical terminology and anatomy so that when they're reading through all of these surgical records or office notes or laboratory notes or findings or pathology that they can interpret what was going on and assign the appropriate.

Code so most of what medical coders do is work with medical records and assign the right codes but they may also talk to physicians or nurses saying hey there's something missing from this documentation to support the code that we need to build this out and ask for addendus or.

Clarification or provide provider queries they may also deal with some of the staff in the practice like the practice manager to make sure that everything that the physicians in the practice are doing are getting correctly coded and billed out.

And the average salary for a certified medical coder according to the aapc salary survey is about 57 000 and again that's average not starting wages so both medical billers and medical coders have important pieces in the revenue cycle puzzle a medical code is going to make sure.

That all these cpt codes modifiers and diagnosis codes submitted on this claim are correct and the medical billers going to make sure that all those things get paid so both of them have a stake in making sure that we're working efficiently submitting clean claims and getting paid.

For all of the great services that the health care organizations are providing and they both are usually productivity based a medical biller will go through a certain number of accounts in a day and make sure that the payments are applied correctly the adjustments are applied correctly or they might just be going through all the denials.

And then working through the denials and trying to get them back out and paid correctly or determine is this something that maybe we really have to write off and medical coders are productivity based too they're supposed to code so many charts an hour that they review all the medical record information.

And then translate it into codes the productivity level for coders is going to vary greatly depending on what type of coding you're doing and also maybe even what type of specialty you're working on and if you're in a large organization as a biller sometimes they split them out differently there are certain billers.

That only work denials for certain insurances and then there's also some that structure it that they work denials for certain practices or certain specialties so they're both two very important pieces of the revenue cycle puzzle and some people really like different things some people like.

Working with the medical records and reading all the reports and assigning the codes other people like getting that money they feel good when they can go after an insurance and get them to pay all the money that they said at first that they weren't gonna pay and it makes you very well-rounded to.

Know both the billing and the coding side because they feed into each other and make for a better revenue cycle and if you're working in a small independent practice you might be doing both you might be coding out all the medical records submitting them for the bills and then following up to make sure they get paid.

I hope that helped clarify the difference between medical billing and medical coding if it did make sure you hook me up with a big thumbs up and don't forget to subscribe and hit that notification bell so you get alerts when i post all these helpful videos or when i occasionally go live for my.

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I will see you in the next video and until then just keep on coding on

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