Medical Billing and Coding

Medical Billing is the process in the medical field where a healthcare claim is generated which is then sent to medical insurance providers. Those insurance providers are then asked to make the payments for the medical services provided by a specific hospital or a doctor.

After the billing claim is made, medical billers then follow the whole process to make sure either the healthcare service provider received their respective payment for the services they provide.

It´s then optimized by the medical biller about how the revenue generation worked for this.

There is another process called medical coding. Both of these concepts are different but have a bit of relativity with one another. As they are connected to the medical industry, it's important for billers and coders to have a better knowledge about medical terminologies, anatomy and pathophysiology so that they can have a better understanding of physician notes and other operative reports.

Both of these concepts are not same but they play a huge role in different portions of the revenue cycle.


Responsibilities of Medical Biller:

Medical Billers interact and play a role of bridge between patient, insurance companies and medical service providers to manage the revenue reimbursements. Billers require some information regarding the patient which includes personal information of the patient, medical history, the treatment he/she received and other insurance coverages.

After the medical biller collects the information, they make the claims ready and then submit them to insurance companies which are also known as Payers.

Payers after receiving the claims, verify it and then they send the payments to the medical billers along with the claim. After completing all that process, it comes to the billers to pay the bills to the medical service provider and submit the receipt to the patient if required.


Responsibilities of Medical Coders:

A chart is made whenever the patient meets the physician for the treatment. Medical Coders use that chart to make standard codes by translating the billable information. Those codes help to elaborate the payers on what treatment is received by the patient and why he/she received that.

Medical Coders use that code to make the payment claims which they sent to the payer as described in the medical biller responsibilities. This cycle keeps on going until the medical service provider receives the complete payment for the service they provided.

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