If you’re considering more of an administrative role within healthcare, consider medical billing or medical coding. While the two are often confused for one another, they are distinct careers. Read on to learn more about the differences (and similarities) between medical billing and medical coding.
How Medical Billing and Coding Differ
Contrary to popular belief, medical billing and medical coding are different careers. Two separate, yet perfectly fitting pieces of a puzzle. They both work toward a common goal, which is collaborating with doctors, patients, and insurance agencies.
Medical Billing
A medical biller receives information from a medical coder, inputs it into billing-specific software, and submits it to a patient's insurance company. They are responsible for creating claims, transaction reports, and patient billing. A good medical biller will be skillful at navigating healthcare laws, regulations, and differing guidelines.
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Medical Coding
Medical coders are responsible for translating doctors' notes. They do so by extracting what is written on a patient's chart and translating it into the correct medical codes, which will be submitted to medical billers who collaborate with the patient's insurance company. It is the medical coder's responsibility to accurately represent everything in the proper coded format, such as tests and diagnoses.
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Types Of Codes You'll Learn
There are very in-depth codes that both medical billers and medical coders must know. The CPT and ICD-9 or 10 are the two main components to any medical claim. When the codes are combined, the report will give an accurate representation of the appointment, including the reason the patient came in and what specific procedures were performed.
- CPT Code: The Current Procedural Terminology code is used to bill outpatient and office procedures. These codes are used along with the ICD-9 and ICD-10 to bill the payer. There are thousands upon thousands of codes within this system. CPT codes are what doctors can charge for, and in turn, get reimbursed by insurance companies.
- ICD9/ICD-10: ICD codes are used to track the incidence and spread of disease and illness across the country. It also will explain to the insurance payer what and why a certain procedure was performed. Codes are three to five digits, either numerical or alphanumerical. In the event of a more detailed disease, subcategories would be used to go into more description. For example, "disease" would be a major category, but following that, more coding would explain where the disease is and how it’s being treated. Of course, it goes deeper than our example as there are over 70,000 codes in this one system for a medical coder and medical biller to be familiar with.
- HCPCS Codes: HCPCS, aka Hicks Picks, are both short for Healthcare Common Procedure Coding System which was developed for Medicare and Medicaid to maintain a way to report medical procedures and services.
Becoming a Medical Biller or Coder
Certification is not required. However, getting certified is highly recommended because most healthcare facilities prefer coders and billers to be certified. The prerequisite to getting the right education is a high school diploma or GED. Classroom and online learning options are available to earn a medical coding or medical billing certification.
Most programs for both coding and billing require courses such as medical terminology, medicine codes, procedure, and supply. Also, an introduction into the medical industry bills and laws such as the HIPAA, Affordable Care Act, Fair Debt Collection Act, and the False Claims Act.
When selecting a medical billing or a medical coding program, one of the most important factors to consider is whether or not the school is accredited. School accreditation matters in a medical billing or medical coding program because it can affect your eligibility to get certified, or even your ability to be employed.
Several certifying organizations such as the American Medical Billing Association (AMBA), the American Academy of Professional Coders (AAPC), and the Medical Association of Billers (MAB) offer prep programs for certification exams.
Qualities to Succeed on the Job
To be a great coder or biller, there are certain qualities that one should have:
- Organizational skills: The billing and coding systems are incredibly complex. Plus, depending on the size of the office you’re employed in, you could be dealing with hundreds, if not thousands, of medical records. Having a knack for organization will be crucial — especially in larger settings.
- Analytical prowess: Both positions have you dealing with records, numbers, and money, so having an analytical mind is essential. Codes must be correct, errors should be identified ahead of time, and accuracy needs to be ensured.
- It’s all in the details: Being detail-oriented is arguably the most important quality to have in billing and coding. There are many layers to medical claims, and being a detail-oriented person can help you catch errors before, or even, after they occur.
- You’re fluent in chicken scratchings: Otherwise known as, a doctor’s handwriting. Being able to read your colleague's handwriting will be helpful. Although doctors don't tend to have the most clear handwriting, if you are able to read between the lines and still have the proper working knowledge of codes, it will be helpful.
- A team player: You’re part of a large team made up of medical professionals and patients. You will need to collaborate with doctors, patients, and insurance companies alike while on the job.
Which Career to Choose
It can be tough deciding on one career in general, let alone choosing between two that appear similar. Benefits are abundant in both areas. For many, one of the greatest determining factors is deciding whether you'd like to work collaboratively versus more independently.
If you thrive and grow working alongside a team, then medical coding might be perfect for you. Whereas, if you prefer working mostly independently, you might prefer billing. Both careers provide much workplace satisfaction. Whichever route you choose, be sure to gain the proper education and certifications that may allow you to excel in the field in the future.
Salary for Medical Billers and Medical Coders in 2021
The Bureau of Labor Statistics reports that the average salary for medical billers in 2022 was $44,800, with the top 10 percent making $60,480. The average 2022 salary for medical coders was $51,090, with the top 10 percent making $75,460. The Bureau of Labor Statistics also reports that demand for medical billers and medical coders is expected to increase 7 percent by 2031 — which is as fast as the national average.