What Do Medical Billers And Coders Do?

Medical billing and coding specialists are largely responsible for making sure medical office revenue cycles run smoothly. When a service is performed, a medical coder assigns codes to the services rendered. The diagnoses and procedure codes are taken from medical record documentation, such as transcription of physician’s notes, laboratory and radiologic results, etc.

Although a medical biller’s duties vary with the size of the work facility, the biller typically assembles all data concerning the bill. This can include charge entry, claims transmission, payment posting, insurance follow-up, and patient follow-up. Medical billers regularly communicate with physicians and other healthcare professionals to clarify diagnoses or to obtain additional information. The medical biller must understand how to read the medical record and, like the medical coder, be familiar with CPT®, HCPCS Level II and ICD-10-CM codes.

As a part of the medical billing process, medical coders in the health information management (HIM) department assign codes to patients’ conditions and procedures. These codes are reported on claims to represent the services the facility provided for the patient and the medical necessity of those services. Clearly connecting what was done in the procedure code – with why it was done. The diagnosis code is essential for maximum appropriate reimbursement. For this reason, patient account specialists need to understand the basics of the medical coding process. This can be only achieved with the help of an expert trainer as what ELATE offers through our Medical Coding and Billing Course.

Medical Coding is essential for the accurate transmission of procedure and diagnosis data between the healthcare providers and the many insurance companies that act as third party payers for the healthcare services rendered to the patients.

Medical Coding Professionals play a key role in the Medical Billing process. Every time a patient receives a professional healthcare in a physician’s office, hospital outpatient facility or ambulatory surgery center (ASC), the provider must document the services provided. The Medical Coder will abstract the information from the documentation, assign appropriate codes and create a claim to be paid whether by a commercial payer, patient or CMS-Center for Medicare and Medicaid.

Billing is a skill that can be learned over time. Coding, however, requires candidates to earn certification in coding prior to being hired for entry-level positions. Billing is the process of completing a UB92 or the standard billing form with demographic information for the patient. Coding creates the appropriate ICD-9 and ICD-10 diagnosis codes for patients based on narratives submitted by licensed medical providers.

Medical billing can be broken down into several areas; > Physician billing > hospital billing > home health billing etc., which are totally different billing and coding processes. Once you become an expert professional in doing expert coding through the Spectrum training, a very promising and lucrative career awaits you.