You may or may not have heard some people describe the medical billing and coding field as an art form rather than a profession.
…Why is that?
The “art” of medical coding and billing is because it includes a diverse range of activities that humans perform, their talents, knowledge, skills and even their emotions. So in a sense this skill is a form of art. Medical coders and billers not only review and track invoices, charge slips and payments, but they also have to analyze patient records in order to construct custom reports that show where the office is most profitable and where there is room for improvement. These reports are a critical aspect of the decision making process when renewing contracts or negotiating contract changes.
They also advise doctors and physicians of changes that are made to the fee structure, ways that the office can improve on their bottom line and new and/or updated coding practices. Medical billers will often find themselves handling dictated transcription. This in turn will save the office money and allow for providers of healthcare to comply with the rules and regulations set forth by the Health Care Financing Administration (HCFA). This organization also clarifies all claims with Medicare.
Medical Billers and Coders: Breaking Down the Differences
Medical Billers- these are the people are responsible for ensuring that everyone that needs to be billed is billed correctly. Some of this work will involve the biller to speak with patients and health insurance companies almost daily to make sure that invoices are paid on time. The biller will not only have to understand the coding language but how to read medical invoices. So the medical biller is a person that is able to handle balancing phone conversations and analyzing data and invoices.
Medical Coders- While medical billers will have to deal with people almost daily; coders on the other hand do not have to. Their job basically surrounds spending time coding the data that they receive and analyzing it. Virtually every duty that is performed in the medical office has a code attached to it and it needs to be done properly in order for the billing to be correct. This also ensures that the medical biller and the coder work side by side to ensure that it is done.
It is important to note that many smaller medical offices will hire a candidate that is able to handle both sides of the job, and some will outsource the job to an agency that handles medical billing.
The Process: Understanding How Medical Billing Works
So now that we have broken down the two positions we will move on to the medical billing process. To sum it all together when a doctor or other health care provider, offers up their services to a patient, regardless of whether it is just a simple checkup or a major operation they are entitled to be compensated for their services. This is true for almost any business that provides services.
After the appointment has concluded it is now when the medical biller will do their job of collecting what is due. The medical biller reviews the bill or forms attached to the patients’ records to establish what services were performed.
Then medical biller must now compare what is attached to the patients chart to the notes from the doctor and/or nurse to verify the codes for the patients’ diagnoses, the codes that mark the duration of the visit and codes for the services performed. Once this is completed they will review the patients’ insurance coverage and will note the health insurance companies name and contact information. This information is also collected once the patient has arrived at the medical office. This is so the medical office can receive the authorization to treat the patient, verify their insurance benefits, eligibility and above all obtain referrals. If the medical office is unable to obtain the proper referral then the claim that they submit will not be approved.
They will also have to pay close attention to the insurance companies benefit statements. This will ensure that the insurance company is online being billed for the procedures that all allowed, the deductibles and the amounts. They will then create the invoices with and then submit the claim.