What’s the Difference Between Billing & Coding?

Though similar, medical billing and medical coding are two separate functions carried out by professionals in the health care industry. Though in many cases these two roles are filled by the same people, this is not always the case. Here is the breakdown between medical billing and medical coding.

Medical Billing

Medical billing technicians submit billing claims to insurance companies, as well as Medicare and Medicaid. They do not always work in an actual doctor’s office, and in fact, many doctors outsource billing to outside small businesses. Some billing technicians are self-employed, working from home.

Billing technicians receive the codes they submit from medical coders, who work from hospitals or doctors’ offices. Technicians need to have a vast knowledge of medical terminology and anatomy, as well as excellent computer skills and patience, as they have to deal with office personnel, medical representatives, doctors and insurance employees on a regular basis.

Medical billing technicians are in high demand as insurance companies and the government have begun to heavily scrutinize medical practices for fraud and abuse. Trained technicians can work for doctors, hospitals, nursing homes, insurance companies, legal offices, rehabilitation centers or independently.

Medical Coding

Medical coders read patient charts and assign the proper codes to specific diagnoses and treatments. They use one or more universal healthcare coding systems, including the Current Procedural Terminology (CPT), a code system established by the American Medical Association, the Health Care Common Procedure Coding System (HCPCS), which is used for medical services involving Medicare or Medicaid (also established by the AMA), or the International Classification of Diseases (ICD), which are assigned for diagnoses and complaints.

Medical coding and billing are inter-related jobs, and students can often get a degree or certificate in both. In fact, the popularity of telecommuting and outsourcing to cut costs makes at-home or self-employed medical billing, or a combination billing and coding, a popular choice.