Medical Billing VS Medical Coding: Is There A Difference?
The medical billing vs medical coding website clearly defines both roles and describes the differences and the similarities between the two professions.
Is there really a difference? Yes, there most definitely is a difference between the two roles and those differences are highlighted by the wages each role makes.
Why Should You Take What I Say About Medical Billing VS Medical Coding To Heart?
My name is Paul G. Hackett and I thank you for taking the time to visit today!
Listen… I could go on a self serving ego-trip right now but I really created this page specifically for your benefit!
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Today, I am going to begin with medical billing vs medical coding because coding is a highly specialized part of the claims and billing process and that is why most employers expect their coders to be certified before considering them as a potential candidate for hire.
Here’s The Process That Happens Everytime You Enter A Doctors Office:
Your doctor listens to your problem is,
They give you a brief physical exam,
They write in your chart = What he is writing is a formula called “S-O-A-P” which stands for Subjective-Objective-Assessment-Plan. He is actually converting what you say and plugging it into this formula along with his observations, conclusions, and any treatments they will prescribe to solve your problem.
Your patient chart is then given to a “Medical Coder”. The coders job is to:
Read your chart,
Match up what was wrong with you with it’s corresponding numerical code from the most current ICD-9 book,
Then they assign the proper diagnosis code with it’s numerical code from the CPT 4 book.
Those two codes and any modifier codes that may need to be used to better describe your problem and its treatment are then placed onto a patient encounter form or superbill.
Your patient chart is then re-filed and you patient encounter form/superbill is given to a “Medical Biller or Medical Billing Specialist” as they are known as in the industry.
Don’t allow the above description to lead you to believe that this is how it is done in every practice because many doctors will do the coding themselves directly onto an encounter form/superbill and give it directly to a medical billing specialist.
Medical Billing VS Medical Coding Continued
Once your patient encounter form/superbill is given to a medical billing specialist it is their job to:
Input that information into whatever form of software package that is used by the practice exactly as it is written. That information is recorded onto either a CMS 1500, UB-04, or ADA form.
The form used is then either electronically submitted directly to your insurance carrier, sent directly to an electronic clearinghouse and when neither of those function can be done the form is printed out and mailed to the appropriate insurance carrier (this is what is know in the biz as “Dropping A Claim or Paper Claim”).
If there is no software at the site your claim will be hand written onto a CMS 1500, UB 04, or ADA form and mailed to the appropriate insurance company for processing.
A medical billing specialists responsibility does not stop there:
They have to follow-up on each and every claim to make sure that is paid. Sometime that can be a burden because they have to spend a lot of time on the phone with insurance carriers trying to get information about specific claims that come back rejected or denied.
They have to deal with patients throughout the day that have concerns about their bills (and let me tell you something, they’re not calling because they’re happy. Lol).
They have to deal with the accounts receivable process where the insurance company sends back the physicians payment and explanation of benefits (EOB’s) for posting into there software.
They have to deal with verifying the status of your insurance coverage.
The biller has to create patient invoices for any money you may owe the practice for co-pays, co-insurances, and any non-covered services.
A medical billing specialist has to deal with denied claims and adjustments to a claim by filing appeals to the correct insurance carrier by getting the necessary paperwork needed to get the claim paid and resubmit them to the proper carrier.
They have to run reports for their employers and be able to explain any the discrepancies that are found and have a plan in place to correct the problems in a timely manner.
If there is no medical coder on site a biller should also make sure that the patient encounter forms/superbills that are being used are equipped with the correct CPT 4 codes and ICD-9 codes to avoid any coding errors on behalf of the physician.
They must actively participate in medical billing organizations or coding associations so that as changes are made throughout the year you can quickly advise their employers and correct any forms that may apply to their specialty (chiropractic, mental health, etc.).
As you can see a medical billers life can be hectic enough with only one physician that sees a fair amount of patients per month but imagine what it would be like if you bill for six different specialties. The funny thing is, to a biller who loves this business even more than the money the amount of work is never an inconvenience.
There may be additional functions that a doctor my ask their medical billing specialist to perform however, I covered the most prominent one’s above.
Medical Billing VS Medical Coding; The Difference In Wages:
There are a bunch of factors that influence one’s salary in both field and the following is biggest contributors:
1) Geographics (North, South, East, West and everything in between)
2) Employment location (city size, rural areas, etc),
3) Employer (hospital, nursing care facility, outpatient care facility, physician office, group practice facility, insurance company, lab or clinic, etc),
4) Your level and years of experience, and lastly
5) Whether you are certified or not.
Taking those contributors into account…
Medical billing specialists can earn anywhere from minimum wage to as much as $28K. It is important to mention here that there are no regulations in the USA that state a medical biller has to be certified but if you become certified as a CMBP (Certified Medical Billing Professional) or CMRS (Certified Medical Reimbursement Specialist) you will find you will earn more than the majority of your counterparts.
Medical coders who are certified can earn anywhere from $24K to as high as $36. If the coder is not certified they will still earn more than a medical biller but they will be earning well below other coders and their employers may request that they get certified within a certain amount of time from their date of hire.
If you start your own medical billing business/service what you earn is calculated differently. Why? Because you set the prices you charge a client so how much you make could be way more substantial than if you were just a billing employee but there are other factors. The following link will take you to a page where I talk more about the salaries of medical billers in the workforce and home based medical billing business owners so check it out if you’re interested!
I enjoyed sharing with you today and I hope I was able to define the differences between medical billing vs medical coding in a way you can clearly understand. For the most updated and detailed information about the proper way to setup, start and operate a successful home based billing business immediately download my ebook entitled “The Medical Billing Home Business Bible” you can’t miss it, it’s located in the column to your right, close to the top
Here Is To Your Success,
”The Medical Billing, Coding & Transcription Mastermind
P.S.: Don’t forget to hover your mouse over the “Medical Billing Tips” tab under the logo a the top of the page for more advice.
External Medical Billing VS Medical Coding References: