Medical Billing and Coding

What is Medical Billing and Coding?

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Medical billing and coding are two different but interrelated processes. In this blog, we will dive into what each one is and how they relate to one another.

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What is medical coding?

Medical coding is the process of assigning codes to medical procedures and diagnoses. These codes help for easy communication between your doctor and your insurance.

Types of codes used in medical coding:

  1. Current Procedural Terminology (CPT). CPT codes describe the services and procedures prescribed by your doctor. These would include routine checkups, lab tests, surgeries, and more.

  2. Healthcare Common Procedural Coding System (HCPCS).  Coders use HCPCS codes for services not covered by CPT codes. This includes medical equipment, supplies, and certain medications.

  3. International Classification of Diseases (ICD). ICD codes classify a doctor's diagnosis. The consistent use of codes for medical conditions helps to provide accurate billing.

What is medical billing?

It's quite simple. This is the process of using patient records to create a bill for the insurance company, called a claim. It involves preparing and submitting claims, verifying insurance coverage, and managing patient payments.

Two types of medical billing:

There are two main types of medical billing:

  1. Professional billing. Professionals like doctors, dentists, and therapists use this method of billing. It involves the handling of claims related to services provided to patients.

  2. Institutional billing. Institutions such as hospitals, clinics, and healthcare facilities use this type of billing. It pertains to claims for services provided by these institutions. These include surgeries, tests, and hospital stays.

The medical billing process

This process consists of several essential steps. Here's a quick rundown:

  • Register patients: Gather patient information and create their profiles in the billing system.

  • Confirm financial responsibility: Check their insurance coverage. Determine whether they should be paying out-of-pocket for any services or procedures.

  • Patient check-in and check-out: Record patient visits, collect co-payments, and update billing information.

  • Prepare claims/check compliance: Prepare paperwork for submission to the patient’s insurance company.

  • Send claims: Submit claims to insurance companies.

  • Track approval of claims: Check the progress of claims to ensure correct reimbursement.

  • Generate patient statements: Prepare and send statements to patients detailing what they need to pay for.

  • Follow up on patient payments: Track and collect outstanding payments. Work with patients and insurance companies to resolve issues.

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What are the responsibilities of a Medical Coder?

Medical coders play a vital role in the healthcare system. Their responsibilities include:

  • Assigning correct codes to medical procedures, diagnoses, and treatments.

  • Reviewing medical records to ensure correct documentation.

  • Keeping up-to-date with coding regulations.

  • Working with the patient’s doctor and insurance company when they question the codes.

What are the responsibilities of a Medical Biller?

Medical billers help ensure that doctors get paid for their services on time. Their responsibilities include:

  • Preparing and submitting claims to insurance companies.

  • Verifying insurance coverage.

  • Resolving issues such as claims getting denied.

  • Following up on unpaid claims and collecting payments.

Final thoughts

Medical billers and coders play a super important role in the healthcare industry. Their expertise helps make the billing process hassle-free for patients. A career in this field offers stability and a lot of growth opportunities.

Take the first step towards a fulfilling career in medical billing and coding! Check out available classes at Dreambound here.

Pia Yapjoco
Written by
Pia Yapjoco

Pia Yapjoco is part of the school growth and sales team at Dreambound. She helps facilitate school partnerships that expand educational opportunities for aspiring students in allied health and other trades. Beyond work, she curates her pup's Instagram, hunts for hidden coffee gems, and escapes into cozy gaming.

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