Difference between Medical Coding and Medical Billing

Although many people refer to medical billing and coding as if it were one job function, billing and coding really are two distinct careers and therefore we offer two different certificate programs: Certified Coding Specialist Preparation or Health Care Billing - Physician and Hospital Billing. Medical billers and medical coders both work in the healthcare setting, such as in hospitals and in physician's offices. They gather information from patients and confer with doctors and insurance firms. As far as pay is concerned, they are also on the same range. The U.S. Bureau of Labor Statistics classifies medical billers and medical coders as medical records and health information technicians which had a mean annual wage of $37,110 based on the agency's May 2015 Occupational Employment and Wages report.

Here is a brief description of the tasks and functions associated with each job and to give you some things to think about to determine which path you want to pursue:

Medical Coders:

In a nutshell, medical coders look at the patient's records to determine what procedures were performed by doctor, surgeon, nurse and the rest of the healthcare team. They would then place the correct procedure code or diagnosis code for the corresponding services obtained by the patient.

In medical parlance, medical coders use Current Procedural Terminology (CPT) to assign the codes related to the procedures received by the patient and refer to the International Classification of Diseases (ICD) to choose the diagnosis codes to label the physician's diagnosis of the patient's condition. It's essential for coders to be accurate in assigning the codes because these are going to be the bases used by insurance companies when processing insurance claims.

Because of the extreme importance placed on accurate coding, medical coders often have to coordinate with other members of the staff in order to get more details about a particular patient. This is integral to the process so that the procedures done and the diagnoses given can be coded correctly. They may also have to inform the staff regarding the kinds of data and information that needs to be made part of the patient's records so that the coding process can go smoothly and efficiently.

Medical Billing:

Medical billing, on the other hand, is concerned with entering the codes into software and processing insurance claims. Medical billers make use of special billing software which allows them to input the codes assigned by the coder as well as other insurance information so that the insurance claim may be sent to the insurer in order for payment to be facilitated. Because they have to deal with insurance companies, billers are expected to know the claims process and the requirements that have to be submitted to process the claims. They are also responsible for handing in the correct insurance claims to the insurer-that is, they have to make sure that they follow the correct billing format, ensure that all fields are properly answered and all the needed documents to support the claim are included in the filing.

Medical billers often have to get the insurance information straight from the patients themselves. They also explain to them the benefits they stand to receive as well as answer any questions they may have about their insurance. In addition, they are also responsible for clarifying the charges that the patients see on their bill. Sometimes, patients get confused about why they still have to pay when they already have coverage. The medical biller then explains deductibles, copayments and coinsurance that their insurer requires.

The work of medical billers does not stop after they have submitted the insurance claims electronically or by mail. They continue to get in touch with patients and insurance firms to determine if the claims have already been paid. If patients say that their claims have not yet been paid, medical billers talk with the insurer to determine the reason for the delay.

When an insurance claim is rejected or denied, they have to talk with the insurance company representative to determine the cause. They also have to talk to the affected patients and inform them about the status of their claims.

Aside from working with patients, medical billers are also essential in medical clinics because they take care of a certain part financial aspect of the work that doctors do. In particular, they see to it that insurance companies are paying the doctors for the services they have rendered.

Common Areas of Medical Billing and Medical Coding:

While both medical coders and billers work in comfortable office settings, the job can be hectic. They have to deal with patients who have questions about their bill and most of the time, they aren't too happy about it. When a claim is denied, they (medical billers, in particular) have to get in touch with the insurer to find out why and resubmit the claims together with the necessary adjustments.

No matter the differences in their responsibilities, both billers and coders must have keen attention to detail. They need to make sure that the codes are entered correctly and that all the insurance data entered into their system is accurate. They also need to have interpersonal skills since they will be dealing with physicians, doctors and insurance representatives. In addition, they also need to know how to use coding software. They must also be able to follow instructions regarding how forms must be filed and sent. An important trait that both medical billers and coders should possess is integrity. The law requires that health information technicians who are dealing with patient data should be able to keep this confidential so that these can be safeguarded.

The employment outlook for medical coders and medical billers looks good in the next few years. The U.S. Bureau of Labor Statistics estimates a 15 percent growth rate from 2014 to 2024, much faster than the average for all occupations. The demand for health services is expected to increase as the population ages.The growth of the elderly population will be the primary driver of demand since they will be seeing their healthcare providers more often and are bound to be subjected to more tests and procedures. Since more claims will need to be filed with insurers, the demand will spawn the need for more medical billers and medical coders.

In short, medical billers and coders together collect information and documentation, code claims accurately so that physicians get paid in a timely manner, and follow up with payers to make sure that the money finds its way to the client's bank account. Both jobs are crucial to the office cash flow of any healthcare provider, and they may be done by two separate people or by one individual, depending upon the size of the office.

Free Career Seminar:   

Still not sure if either of these careers are right for you? Attend our free career seminar. This career seminar is led by experienced professionals who will offer real advice about career and academic paths and talk about both the satisfactions and challenges of their own chosen careers. The seminar is one and a half hours long, given in the evening and is usually offered 2-3 times a year - every January, May and September. There is no charge for the seminar, which is held on our Rockville Centre campus. Click here for a current schedule of classes and to register.


If you should have any questions regarding this program, please call the Office of Continuing Education at: 516.323.3550 or email: conted@molloy.edu.