Many people refer to medical billing and coding as if they were one synonymous job, but they are two very distinct roles in the healthcare revenue cycle. Though in some smaller facilities, one person may take on both roles, in most larger healthcare facilities, these are often two separate positions. Both are extremely important to the functionality of a medical facility, and operations depend on accuracy in both coding and billing. Below, we’ll look at the responsibilities, duties, and personality traits of medical billers and medical coders.
What is Medical Coding?
Medical coding is the process of translating all the information about a patient visit into universally understood alphanumeric codes which are used for insurance billing, medical records, government agencies, and healthcare providers. Medical diagnoses, procedures, diagnostic tests, treatments, prescriptions, and medical equipment used during the visit are each transcribed into standardized codes which are universally agreed upon. These codes are used in the private and public sector by healthcare, insurance, and government entities. Medical coding for each patient visit must be accurate, because the revenue cycle of the medical facility depends on insurance companies processing claims quickly.
What Does a Medical Coder Do?
Medical coders translate the details of a patient visit into a set of alphanumeric codes which can be used by the medical biller to submit an insurance claim, and for accurate medical records. The patient diagnosis, treatment, procedures, tests and lab reports, and any other information is encoded by the medical coder.
These medical coding systems are used everywhere in the US.
- ICD-10CM (International Classification of Diseases, 10th Revision): The ICD-10CM is maintained and revised by the World Health Organization, about every ten years. The ICD-10CM classifies every disease, injury and symptom known to the worldwide medical community.
- CPT® (Current Procedural Terminology): Used in the US, CPT® codes are designed to report and encode medical, surgical and diagnostic procedures administered in a medical office. The CPT® codes are also the same as Level I of the HCPCS coding system.
- HCPCS (Healthcare Common Procedure Coding System): HCPCS was designed for use by government insurance payers like Medicaid, and Level II of HCPCS is for non-physician medical services, medical products and supplies, and provides codes not covered by CPT®.
Medical coding requires a nuanced understanding of medical terminology, anatomy, physiology, medical coding guidelines, and medical billing regulations, as well as healthcare treatments and procedures. Accuracy is of absolute importance, as how a report is encoded can affect insurance billing, and therefore the revenue cycle of the medical facility.
What is Medical Billing?
Medical billing is the process of submitting claims to insurance companies for reimbursement for medical services that have been provided. Medical billing also includes making sure the patient pays their portion of the bill after the insurance payer pays their allocated amount.
The medical biller takes the patient visit information transcribed by the medical coder and then prepares an insurance claim for submission. Medical billing specialists make sure the claims contain the necessary patient information, follow up on claims for payment status, dispute and correct unpaid claims, and record payments made by patients and other payers.
What Does a Medical Biller Do?
Medical billers take the records created by the medical coder and create and submit a claim to the insurance companies. The medical biller makes sure patient information in the claim is up to date so there is no processing delay. Billers work directly with the insurance company to resolve claim denials and fix rejected claims. They also follow up with insurance companies and patients to ensure the healthcare facility is compensated on time. Once the insurance payer has reimbursed their portion of the bill, the medical biller sends an adjusted billing statement to the patient so they can pay the remaining balance.
Medical billers are responsible for determining patient eligibility, filing claim appeals, overall billing accuracy, and managing patient payment plans. In smaller medical offices, one person may fill the role of medical coder and biller. In larger healthcare facilities, like a hospital, there may be separate people who do each job in communication with one another.
What are the Differences Between Medical Coding and Medical Billing?
There is an overlap with the roles of medical billing and medical coding, even though they are separate job roles. They rely on each other to complete the patient billing process and accurately file insurance claims for patients, so the medical facility gets reimbursed. But there are major distinctions in these two roles.
Medical coders must encode all the details of a patient visit with great accuracy. The medical biller uses this information to submit a claim – this information is also put into electronic health records. Medical coders usually do not interact directly with patients but communicate with other healthcare workers.
Medical billers use the information the medical coder prepares to create an insurance claim. They also spend time scrubbing claims to make sure the information fits the format of the insurance payer – they each have their own requirements. Billers also work with the payers to resolve claim denials. Much of their time is spent preparing and scrubbing claims, and communicating with insurance companies to fix denied claims. The remainder of their time is working with patients to receive their portion of the bill, helping to explain any costs to them. Empathy, communication, organization, and attention to detail are all useful traits for a medical biller.
Personality Types for Billers and Coders
Do you find it easier to work autonomously by yourself with analytical problems? Or are you more extroverted and communicative with others? Each of these roles has its own set of interpersonal and inherent skills.
Medical Billers
Communication is one of the most important traits for a medical biller. In this job, you’ll spend time communicating with insurance companies and patients to resolve coverage, claims, and make sure the medical facility is reimbursed. Extroverts with a knack for customer service, empathy, diplomacy, and problem-solving are most adept in this job.
Medical Coders
For those who are most comfortable working independently and solving analytical problems, medical coding may be a good career for you. Medical coders must carefully interpret the details of a patient’s appointment and match the right codes to the report. People who are detail-oriented and comfortable working to solve problems on their own excel at medical coding.
Salary for Medical Billers and Coders
In some clinics and medical offices, one person might be responsible for both medical coding and medical billing. In some healthcare facilities, the medical coder works remotely, and the medical biller works on-site. With that in mind, here are the number for salary for each of these jobs.
According to the Bureau of Labor Statistics[1] in May 2023, medical records specialists, including medical coders, across the US earned a median average salary of $48,780 and an average median wage of $23.45. How much you earn will depend on several factors, including your location, years of experience, and additional coding certifications you have earned.
In California, as of May 2023, medical coders earned a mean average salary of $64,070 and an hourly mean wage of $30.80.
Medical billers, when it is a separate job from medical coding, falls under the job category of billing and posting clerks. According to the BLS, in May 2023, medical billers across the country earned a mean annual salary of $47,120 and a mean hourly wage of $22.66. In California in 2023, medical billers earned a mean annual salary of $53,330 and a mean hourly wage of $25.64. In Sacramento in 2023, their annual mean salary was $52,410 and their mean hourly wage was $25.20.
What Training Do You Need for Medical Billing and Coding?
Most employers look for candidates who have completed a certification program and passed an exam from a recognized certification body. These are the ones that are most commonly used by medical billers and coders starting their career.
- Certified Medical Reimbursement Specialist (CMRS) exam offered by the AMBA (American Medical Billing Association). This is for medical billers.
- Certified Coding Associate (CCA) exam offered by the AHIMA (American Health Information Management Association). This is the certification most employers look for in a medical coder.
- Certified Billing and Coding Specialist (CBCS) offered by the National Healthcare Association (NHA). This is a certification for medical billers and billing and coding specialists.
Become a Medical Biller and Coder in 42 Weeks With Our Online Program
If you want to start your career as a medical biller and coder, Campus Sacramento, formerly MTI College, has an online program that will give you the training you need to begin your career. Our Medical Billing and Coding Professional program will teach you vital coding and billing skills in 36 to 42 weeks (depending on transferrable credits). Get the job that you want to have, all while studying online! For more information, contact our Admissions team or call 888-675-2460.
[1]: The data provided above are from a source unaffiliated with Campus, formerly known as MTI College, are for informational purposes only and represent the employment field as a whole. They are not solely specific to Campus graduates and, by providing the above information, Campus makes no representation, direct or implied, or opinion regarding employability.