Medical Billing and Coding

In the allied health occupational field Medical billing and Coding are two closely related job areas in the medical administration area. As each one relies on the other, there is often the opportunity to combine these two fields – and somebody whose skills are honed in both can often either get a higher paying position or increase their general job prospects as there will be more job opportunities for them to select from.

A medical biller formulates and submits claims for services provided by healthcare professionals to the agencies responsible for their reimbursement. They may also be in charge of preparing, reviewing and forwarding patient statements, for identifying and helping to resolve patient billing complaints, and answering billing-related questions that might arise on the part of patients, insurance companies or other staff. If insurance companies or government agencies like Medicare dispute a bill, the medical billing and coding staff become responsible for clarification in follow up phone calls and letters.

Also a medical biller works from the other end – at insurance companies. Here the biller makes sure that an insured has paid his or her portion of the cost for medical service (i.e. the deductible), and that the entire medical bill is thus taken care of. Often there are disputes as to what an insured should pay versus what the insurance company is responsible for, and the medical biller works to sort out these problems and collect payments.

Medical Billing and Coding Field

In the Medical Billing and Coding field, medical coding is a more specific focus that deals with the same basic branch of medical administrative/office work. In order for information to be transferred easily among the parties involved in a medical transaction – usually health care provider, patient, and insurance company, – there are various alpha numerical codes used that designate diagnoses, medical procedures, medications (pharmaceutical codes), and even various areas on the body (known as topographical codes). The medical coder is an expert in these codes and makes sure that medical documentation is accurate.

Often the coder takes the basic data in a patient’s file – the doctor’s diagnosis of a patient’s condition, what treatment was given both in terms of medical procedures, medications, and doctor recommendations, and so on, and converts all this data into the appropriate codes. Thereafter, the different code groups must be associated together on a single medical document or bill so that accurate cost information can be arrived at. The codes are recognized all across the medical industry, allowing for quick processing of insurance claims, assessment of required payments, and general clarity concerning a patient’s status.

Medical coding is a key component in medical billing solutions: for obvious reasons a three-digit code works better on an invoice than a sentence of polysyllabic words. So it should be fairly obvious how these two fields are connected. A medical biller needs either to work with a medical coder or know medical coding himself or herself in order to accurately document medical information. The two skill sets being closely related and interdependent as they are, educational programs often combine medical billing and coding into a single curriculum. So if you’re considering getting into this type of field, consider looking for education programs that offer instruction in both. Simply do an internet search for “medical billing and coding training” or something similar, rather than one or the other by itself, and you’ll find a plethora of educational programs.

Of the two fields (Medical Billing and Coding), medical coding is considered slightly more highly skilled. But if you can get a good handle on both, you’ll be that much more employable. There is nothing wrong with specializing in one or the other, and they are roughly comparable in pay. But if you do specialize in one of these, make sure you know it well. There are a lot of job possibilities in Medical Billing and Coding but it’s your responsibility to be as well trained as possible in whatever field or combination of fields you choose.