While medical billing and coding are closely related, they are also very different. Despite their differences, however, they are dependent on each other.
Medical coding involves translating a doctor’s diagnosis or prescription into a coding language that is comprehensible to insurance companies. Medical billing involves crafting a claim using the codes made by the medical coder and sending it to the insurer.
This blog will help you better understand medical billing and coding differences. We will also discuss finding the right medical billing and coding service provider for your practice. Let’s start without any delay.
Medical billing and coding are the most crucial parts of revenue cycle management for healthcare providers. Both lead to payment collection from insurers or patients.
Medical billing starts the moment a patient schedules an appointment with the doctor. The medical biller begins by checking the patient’s insurance coverage. A medical billing specialist’s responsibilities keep going until the practitioner receives the payment and it is updated on the EHR.
Medical coding, on the other hand, starts when the patient visits the doctor. The task of a medical coder is to translate the patient’s diagnostic report and prescription into a language of numeric or alpha-numeric codes. A medical coder must be very careful with the codes, as the slightest mistake can change the prescription, resulting in claim rejections or denials.
Let’s use a real-life example to better understand the medical billing process. A patient schedules a primary care appointment with a doctor. The medical biller first checks the patient’s insurance coverage. If the insurance does not cover the specific service the patient needs, the biller might have to contact the insurer to ask for prior authorization.
After the patient has visited the doctor, the biller has to make a claim for all the services provided to the patient. The claim is then sent to the insurer for reimbursement. If there is some issue with the claim, the insurer might reject or deny the claim.
Once a claim is rejected or denied, the biller will identify the reasons for rejection and follow up with an updated claim. In case of denial, the biller must contact the insurer to discuss the issue. Sometimes, the insurer may agree to pay a specific amount for the claim. The biller also must contact the patients regarding copays, deductibles, or other payments.
The job of a medical coder starts when the patient visits the doctor. The coder has to record every action performed by the doctor or the nurses on the patient during the visit.
For instance, the nurse checks the patient’s blood pressure and temperature, and the doctor runs a few tests to diagnose the problem. Everything, from checking blood pressure to making a diagnosis, should be written in a specific language of numeric and alphanumeric codes.
A medical biller then organizes these codes to make a claim, which is then sent to the insurer for reimbursement.
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Practitioners these days prefer hiring virtual medical billers and coders for the perks and benefits that come with these service providers.
The primary benefit is the reduced overhead costs, as virtual medical billing and coding companies charge a small percentage of your collections. Moreover, you don’t need to worry about paying for the space and equipment as they will work remotely.
Virtual medical billing and coding companies hire resources after passing them through a thorough examination. Medical billers and coders at such companies are often professionals with several years of experience in their respective fields.
Virtual billing and coding companies ensure timely collections as they get paid for the revenue they have collected. This not only ensures timely collections but also minimizes your denials as the company tries its best to get maximum payment for its services.
Billers and coders working at professional companies are vetted after a detailed hiring process. Hiring expert onsite billers and coders may take you up to several weeks or even months. Meanwhile, signing a contract with the right billing company can give you access to top talent within days.
While virtual billers and coders come with their benefits, there is a downside to take care of.
Hiring virtual billers and coders who are not aware of the regulations and laws might cause compliance issues. To ensure compliance with HIPAA, you must look for the right company with a good reputation.
While finding the right billing and coding service provider can be challenging for healthcare providers, a few key elements can make the process much easier.
Choosing the right billing partner is crucial to the growth of any healthcare practice. Now, it’s up to the provider to decide whether they prefer an onsite medical billing and coding team or a virtual one.
Overall, both onsite and virtual medical billing and coding come with their pros and cons. Make sure you are aware of the ups and downs of both options before going for either one.
Virtual billers and coders often use electronic medical records (EMR) software like Epic, Cerner, or Athenahealth, as well as coding tools like CPT and ICD-10 references.
Reputable companies, like EZ MD Solutions, offer continuous education and training to keep their staff updated on changes in coding standards and compliance regulations.
Yes, many virtual teams include patient support services, addressing questions about copays, deductibles, and payment plans directly with patients.
Virtual providers often have dedicated denial management teams that focus on quickly identifying and resolving issues. This results in fewer delays and improved reimbursement rates.
Immediately communicate with your virtual service provider to review the claims in question. They can identify and correct errors to avoid claim denials or penalties.
At Medi Billing, we provide comprehensive medical billing services that cover everything from coding and claims to payment recovery. We take the stress out of your revenue cycle across all specialties so you can dedicate your time to patient care.
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