When we think of the healthcare system, doctors and nurses are often the first professionals to come to mind. However, there are a variety of important occupations that extend beyond patient care. Medical billers and medical coders, for example, are essential professionals that keep medical practices up-and-running. They help ensure healthcare providers are paid for their services, keeping facilities afloat.
Medical billers and medical coders are often viewed as one-in-the-same, but these professionals actually serve distinct purposes in the healthcare system. If you are considering a career in medical billing and coding, it’s important to understand these differences. To help you get started, we’ve unpacked the differences between medical billing and coding, as well as their functions and requirements, below.
What is medical billing?
Medical billing is the process of submitting claims to insurance companies, so that healthcare providers can receive payment for any services rendered to their patients.
Medical billing begins with signing patients in and verifying their health insurance. Following a patient’s visit, the services received, as well as their diagnoses, will be translated into standardized codes (by a medical coder) that can used for insurance claims. This coding is crucial for accurate billing. The codes are then entered into a billing system, and claims are submitted to the insurance companies. Medical billers follow this process from start to finish, ensuring that medical bills are correct and that providers are reimbursed for their services.
This means that, once a claim is submitted, medical billers will also track the claim status, address any issues, and record payments received from insurance companies and patients. Sometimes, this involves billing patients for any remaining balances and, if necessary, working with collection agencies for unpaid bills. Medical billing also involves generating financial reports to monitor a practice’s revenue cycle.
Ultimately, accurate medical billing is vital for the financial health of healthcare providers, ensuring they are properly compensated for their services and to keep the practice running efficiently.
What is medical coding?
Medical coding is the process of translating healthcare diagnoses, procedures, medical services, and equipment into standardized codes. These codes are derived from various universal coding systems—such as the International Classification of Diseases (ICD), Current Procedural Terminology (CPT), and Healthcare Common Procedure Coding System (HCPCS)—and used to formalize and summarize patient documentation in an accurate, standardized manner.
As suggested above, medical coding is an essential component of the medical billing process. Medical coders review patient records and assign the appropriate codes to the care provided, ensuring that billing and documentation are accurate, and that providers are reimbursed for their services. This is critical to receiving compensation from patients, insurance companies, as well as government programs like Medicare and Medicaid.
In addition to facilitating medical billing, medical coding also ensures compliance with regulatory requirements, supports the collection and analysis of public health data, and helps to inform research, policy-making, and resource allocation in the healthcare system.
Overall, the primary purpose of medical coding is to create a uniform language that documents medical services in an accurate, accessible manner for healthcare professionals.
Key differences between a medical biller vs. medical coder
As you can see, medical billing and medical coding go hand-in-hand. However, they both serve distinct functions. Medical coding is used to translate patient information and healthcare services into a universal, standardized language that providers, insurance companies, and government entities can understand. Medical billing is used to submit claims, receive payments, and track the billing of healthcare services provided. To put it simply: Medical coders translate medical services into codes, while medical billers ensure payment is received for those medical services. These professionals serve different purposes, but cannot function without one another.
Because medical billers and medical coders have different responsibilities, their skillsets are often unique. They also differ in how they work with patients, providers, and external companies. As you weigh the medical coder vs. medical biller careers, consider these factors:
- Medical billers work with people.
Medical billers are mediators, often needing to communicate directly with several parties to facilitate the billing process. Medical billers are often on the phone with patients, insurance companies, government agencies, and providers to track claims and invoicing, as well as resolve issues that arise regarding payments. Medical billers must be strong in interpersonal communication, conflict resolution, and organization, as well as have the technical skills needed to compute medical bills.
- Medical coders work behind-the-scenes.
Medical coders are vital to the healthcare system, but typically take a more behind-the-scenes role. While they will occasionally collaborate with other healthcare staff (like providers and administrators), medical coders will spend their days working within a computer system and do not have direct contact with patients. With that in mind, medical coding might be a good career fit for someone who is more analytically-minded, detail-oriented individuals who are looking to step away from a patient-centered or clinical role. Rather than requiring strong communication skills, medical coders need a deep understanding of medical terminology and coding systems, as well as knowledge in anatomy and physiology.
If you are interested in becoming a medical biller or a medical coder, check out our free guide to getting started!
Medical billing vs. medical coding: You don’t have to choose.
Both medical billing and medical coding are great ways to break into the healthcare field and make an immediate impact, without investing a lot of time in school. To become a medical coder or a medical biller, the requirements are the same: Postsecondary training and certification is recommended.
This means you do not have to choose between a medical billing or medical coding career right now. You can take time to explore your options, interests, and talents through a postsecondary training program. Many postsecondary programs combine both medical coding and medical billing into one, comprehensive curriculum – enabling you to learn the ropes of both career paths. For example, in Goodwin’s medical billing and coding program, you will learn all about:
- Medical insurance and billing
- Different types of medical codes, including CPT and ICD
- Medical office management
- Medical law and ethics
- Medical terminology
You will also have the opportunity to participate in an internship experience, where you can put learned skills to practice and gain experience in a real working environment. This program can be completed in just 12 to 18 months.
At the culmination of Goodwin’s medical billing and coding program, graduates are eligible to take the Certified Professional Coding exam through the American Academy of Professional Coders (AAPC). This certification can give you a competitive advantage when applying to both medical coding and medical billing career prospects.
Additionally, as you research job opportunities in the medical billing and medical coding space, it’s worth noting that you might find positions seeking candidates who can serve both functions. Typically, small businesses (like private practices and physician’s offices), you will find professionals who handle both medical billing and medical coding as part of their day-to-day role. Meanwhile, in larger organizations (such as hospitals), you might find these careers are split, requiring both coders and billers to keep operations smooth. So, if you want to wear both hats, the options are out there for you!
No matter where you see yourself fitting in, know that you will be entering a highly impactful field. As explained by the AAPC, both “medical coding and billing are critical for maintaining accurate patient records, ensuring efficient communication among healthcare providers, and managing healthcare costs.”
Not to mention, the medical billing and coding field is brimming with opportunities, as the Bureau of Labor Statistics expects faster-than-average job growth for professionals. If you are interested in getting started, now is the time!