Deciding between medical billing and medical coding can be difficult, especially if you’re navigating the healthcare industry for the first time. While they may seem the same, they've specific roles in ensuring smooth financial operations. 

Both are important for running a healthcare practice, but which one to select? As a company offering both services, we understand the confusion and are here to help you make the best choice for your needs.

What Is Medical Coding?

Medical coding interprets health diagnoses and procedures into specific codes. These codes create a standardized language that healthcare providers and insurance companies use to manage billing, process payments, and maintain records. Medical coding simplifies precise healthcare information, which makes it easy to manage financial and administrative responsibilities in healthcare. 

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Types of Medical Codes

1. ICD-10 Diagnosis Codes

ICD-10 diagnosis codes are used to categorize various symptoms, conditions, and signs that a patient experiences. These codes help track fitness, manage care and manage reimbursements.

ICD-10-CM is a more detailed version of ICD-10 that gives additional codes and updates for better clarity of the health diagnoses. It is used in outpatient care and includes new categories like "complications of care" to assist doctors and healthcare providers to capture patient information correctly.

These codes are divided into three levels: 

• Diagnosis

• Manifestation

• Etiology

2. CPT and HCPCS Procedure Codes

CPT codes are an important resource used by healthcare specialists to keep track of current procedures, with regular updates to guide how different services need to be billed.

HCPCS is a system used for non-physician services and medical supplies. These codes include things like long-lasting medical equipment (DME) and ambulance services, which are crucial for billing and managing healthcare expenses. They also play a key role in monitoring quality of care and controlling costs.

3. Charge Capture Codes

Charge capture codes are used to record the details of services a patient receives and their associated costs. These codes document the procedures, departments involved, and any additional items or charges. They play an important role in documenting services for billing, making sure that the services provided are billed accurately and quickly.

4. Professional and Facility Codes

Professional and facility codes are used to identify the services provided by healthcare professionals and institutions, such as doctors, hospitals, and clinics. These codes focus on the financial details related to the services provided.

Medical coders need a deep understanding of medical terminology and human anatomy to interpret records correctly, assign codes, and keep billing precise. Their attention to detail and organizational skills are vital to maintaining accuracy in the billing process, especially under pressure.

What Is Medical Billing?

Medical billing is the process of sending claims to insurance companies and monitoring them to secure payment for the care patients receive. It connects healthcare providers with insurers while allowing patients to get the care they need. By handling these claims efficiently, medical billing bridges the gap between healthcare and financial obligations, benefiting providers and patients.

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Types of Medical Bills

Medical billing can be complex, and patients may receive multiple types of bills from healthcare facilities. These include:

• Explanation of Benefits (EOB)

• Patient Statements

• Electronic Remittance Advice

▪ Front-End Medical Billing

Front-end starts with entering patient details into the provider's system and creating claims based on that information. It involves collecting all the necessary details to make the claims accurate and easy to process. Getting things right at this stage helps avoid delays later.

▪ Back-End Medical Billing

Back-end deals with insurance companies to address issues like claim denials and appeals. It may be handled by in-house staff or a billing professional. This step includes managing provider information, service dates, codes, and other essential data to finalize the claims. 

Key details include: 

• The provider’s name

• NPI (National Provider Identifier)

• Service dates

• Relevant codes.

How are Medical Billing and Medical Coding Related?

Medical billing and medical coding both play important roles in the financial side of healthcare. They are closely connected and work together to ensure that healthcare providers are paid for the services they provide.

It all starts with medical coding. Coders assign specific codes to the diagnoses and procedures a patient receives. These codes are like a universal language that allows healthcare providers and insurance companies to communicate about the services.

Once the medical coder assigns the right codes, the biller steps in. They use those codes to prepare and submit claims to insurance companies. Sometimes, billers may also check the codes to make sure they’re accurate before sending out the claims. While some healthcare billers also handle coding, it’s not always the case.

These codes bridge the gap between the billing department and insurance companies. Insurance companies use the codes to identify the services a patient receives, so they can determine what’s covered under the patient’s insurance plan and calculate any costs that need to be paid.

Which One to Choose?

Medical billing and coding are two critical roles within the healthcare industry, each with different responsibilities.

Medical billers are responsible for the financial aspect of healthcare. They submit insurance claims, follow up on denials, and collect payments from patients. They should have knowledge of coding regulations to make certain billing is accurate. 

On the other hand, Medical coders translate healthcare diagnoses and procedures into standardized codes. It involves reviewing clinical data, assigning correct codes, and ensuring compliance with coding guidelines. Coders must have strong attention to detail and organizational skills to record each patient’s health information correctly.

Why Choose Dilijent Systems?

We understand the complexities of healthcare. Whether you’re managing a clinic or running a large hospital, we’re here to help. Our medical billing and coding services are designed to take the stress off your shoulders so you can focus on your patients.

What We Offer:

• Experienced Experts

• Customized Approaches

• Simplified Processes

• Error-Free Claim Submissions:

• Ongoing Support

• Cost-Effective Services

Conclusion

Medical billing and coding are essential components of a successful healthcare organization. Instead of choosing among the two, why not get the best of both worlds? Our professionals can guide you through your options and offer the help you need to succeed. 

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Let us handle the complexities with our expert services. Contact us today!

FAQs

What are billing services?

Billing services include different tasks like sending invoices, verifying insurance, following up on bills, and monitoring reimbursements.

What is the basic medical billing workflow?

It involves 

• Registering patients

• Checking insurance

• Assigning codes to services

• Submitting claims

• Tracking payments.

What are the different types of billing methods?

There are three main methods: 

• Time-based (charging by the hour)

• Usage-based (charging for services used)

• Feature-based (charging for specific features).

What does EOB stand for in medical?

Explanation of Benefits (EOB) shows the charges for a visit and explains what your health plan covers and what you need to pay while billed by your provider.