What Exactly Does a Medical Biller and Coder Do

What does a Medical Biller and Coder do? If you want to know that information, you have to read this entire article. Here we are going to explain what a Medical Biller and Coder do. Keep staying on this page and make sure you will not miss any information.

What Is Medical Billing And Coding?

Medical billing and medical coding are jobs that facilitate payment between health care providers, the patients and insurance companies. Now, let us look at each specific job, and how they assist medical offices run smoothly. Usually, there are some overlaps between medical billing and coding, however this is a brief way to describe each job.

    • The Medical coders transcribe a patient visit and physician’s treatment into a series of universally agreed-upon codes. Those codes are utilized by health care providers, hospitals, insurance companies to create a record of a patient’s visit and submit an insurance claim. Each code has guidelines on how they are able to be used, so accuracy is crucial.
    • The Medical billers take the codes prepared by the medical coder and submit claims to the insurance company. Then, they follow up with the insurance company and the patients to ensure the medical office is compensated properly, the patient is billed properly, and timely payments are made.

What Exactly Does a Medical Biller and Coder Do

What Does A Medical Biller Do?

The medical billers must take the coded transcript from the patient visit. Then, input that information into special software. That information is submitted to the patient’s insurance company as a claim. Once the insurance company pays their portion, then the remaining amount is billed to the patient. Remember that any co-pays and deductibles are figured into this revised amount. As with medical coding, accuracy is really crucial in medical billing.

The medical Biller and coder work in tandem to ensure that the health services are being tabulated accurately. That information is passed to the insurance company. The invoice is sent to the patient. Both medical Billing and coding jobs are very crucial to make sure that the health care facility is reimbursed properly.

The medical biller plays an important vital role in the relationship among medical providers, patients and also insurance companies. Even though the medical biller is not responsible for patient care, she or he must have a good understanding of medical terminology to be able to discuss medical bills with insurance carriers and patients.

Here are some duties of a medical biller:

    • A medical biller must audit and submit claims to insurance companies for the patient procedures and treatments.
    • A medical biller must get insurance referrals and pre-authorizations for the patient procedures.
    • A medical biller must verify insurance eligibility and benefits.
    • A medical biller must understand insurance guidelines, including those for Medicare,  Medicaid, and HMO/PPO.
    • A medical biller must review patient bills for accuracy and fill in any missing information.
    • A medical biller must check payments for accuracy.
    • A medical biller must research and appeal denied claims.
    • A medical biller must talk with insurance companies regarding payment discrepancies.
    • A medical biller must set up payment plans for patients.
    • A medical biller must collect delinquent accounts.
    • A medical biller must answer phone inquiries from the patients and insurance companies.
    • A medical biller must use medical billing software to perform job duties.
    • A medical biller must update software with rate changes.
    • A medical biller must know Fair Debt Collection Practices.

As a medical biller, you may not do each of those duties every day, however they are all considered responsibilities of the job.

What Does A Medical Coder Do?

The medical coders must transcribe what occurs during a patient visit so that the insurance companies and health organizations are able to know it. As a Medical coding specialist, you have to take information, such as a patient’s symptoms, physician’s diagnosis, or a doctor’s prescription, and change that into numeric or alphanumeric codes. Those codes explain each injury, diagnosis, prescription, and medical procedure. This is very crucial for both the patient’s medical records, the doctor’s office or hospital, and the insurance claims processor. The medical coder is a translator for each of those entities, tabulating what occurs during a patient appointment.

The standard which is almost universally used is the International Classification of Diseases (ICD). In the United States, Healthcare Common Procedure Coding System (HCPCS) is used to submit claims to Medicare and other forms of health insurance. For your information, HCPCS has two levels: Level I and Level II. Also, HCPCS Level I is known as CPT (Current Procedural Terminology).

Whenever you visit your physician or health care provider, each part of your visit is notated by the doctor or medical assistant. The medical coder utilizes the coding standards to collect a record of your doctor’s visit. Each code will match up to a sickness, a service provided by the medical office, a prescription, or test. Usually, this record is utilized by a medical biller to submit a claim for the insurance company.

It is really crucial for the medical coder to transcribe the record of the visit accurately. Each code has its own guidelines, and rules for the order in which they are placed. If the coding is done incorrectly or inaccurately, it will be able to affect the status of the insurance claim. After the codes transcribing the patient visit are input into the computer, that information is passed along to the medical biller.

Here are some duties of a medical coder:

    • A medical coder must review and analyze clinical statements & patient records
    • A medical coder must translate diagnosis and medical information into codes by using CPT, ICD-10-CM and HCPCS Level II classification systems
    • A medical coder must interact with physicians and assistants to make sure the codes are accurate and ready to be converted into a medical billing claim.
    • A medical coder must maintain patient confidentiality and information security.