Medical Billing and Coding: Two Functions with Related Potential

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Many people new to the medical billing and coding industry believe these two functions are the same thing. In reality, many companies treat the jobs separately, although the skills sets are closely related. This article provides a detailed description of each function and a brief overview about what sort of job opportunities are available to individuals with medical billing and coding experience.

Medical Billing

Medical billing refers to the work completed by a provider of healthcare services in order to receive payment by insurance companies and patients. Often, this is referred to as claims adjudication. Although details within the process for each provider or treatment type vary, the basic premise for billing remains the same throughout the industry. This means someone with medical billing education or experience can adapt their knowledge to a growing variety of job opportunities.

Medical billing work consists of the creation, transmission and follow up of insurance claims and patient statements. Depending on where an individual works, daily functions performed in the scope of a claims billing job might include:

  • Preparing electronic or paper claims;
  • Data entry;
  • Reviewing claims to ensure quality;
  • Checking medical records to ensure documentation requirements are met;
  • Calling insurance companies or physician’s offices to clarify information;
  • Entering claims online;
  • Checking claims status online or via telephone,
  • Following up on non-paid claims,
  • Speaking to patients regarding information for claims;
  • Following up with patients on outstanding invoices; and
  • Re-filing claims.

Small providers and offices usually have one or two staff members who complete all billing work while hospitals and large providers have entire departments dedicated to this task. There is usually more room for moving up with a larger provider, but smaller offices allow for diversity of work.

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Medical Coding

Medical coding is the process of using an alphanumeric coding system to indicate procedures and diagnosis in a patient’s medical records. These codes are used to standardize medical communications for clarity among practitioners, as well as to transmit information to insurance companies for payments. Proper coding is essential in today’s technologically advanced health care environment. The diagnosis, procedure and medication codes are entered into systems at hospitals. The system uses the codes to ensure medications will not interact negatively with each other or the patient. Coding also ensures that procedures ordered are applicable to the diagnosed condition. Failure to property code items can result in improper care and injury to the patient.

Accurate coding is also required for payment of claims. For example, if a claim is submitted with a gender of male and the diagnosis code is related to pregnancy, the claim will not go through. Similarly, claims with procedure codes that are not deemed relevant to the diagnosis will be denied.

Medical coding is closely related to medical billing. In some offices, the same person performs the functions. In hospitals and large facilities, there are often separate medical records departments that employ coding experts.

Medical Billing and Coding Job Opportunities

Health care administration is one of the fastest growing careers in the country. As insurance companies attempt to save costs, accurate and efficient claims filing processes grow in importance for all providers. Someone with education or experience in medical billing and coding can expect to find job opportunities in hospitals, physical therapy clinics, physician’s offices, optometry and dental offices, rehabilitation facilities, nursing homes and off-site medical consulting firms. Medical billing clerks make an average of $22,000 to $32,000 per year in the United States. Certified medical records and coding experts can make up to $50,000 per year on average.

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