As a medical biller, you may generate bills for services rendered, but as a coder, you would use a specific code for that service. Most of the time the biller and coder are one and the same person with specific knowledge in the fields of medical billing and coding. In-depth training is necessary to handle coding and billing to make sure payments are made by insurance companies.
History
During the Crimean War, Florence Nightingale began to collect data about patient illnesses, injuries and treatment. Since then, physician practice, diagnosis and record keeping has become a major focus. It wasn't until the 1990s that new emphasis was put into play on medical evaluations and billing concepts including more stringent protocols. This allowed for specific knowledge to be attained for coding and billing purposes that provided a payment structure for medical bills and the codes used to specify the treatment given.
Types of Billing and Coding
Hospital billing and coding differs from that of a doctor's office visit. Since the stay or treatments vary greatly in each of these areas, different codes and treatments are necessary. As an example, a doctor would charge for an office visit while the hospital would bill for emergency treatment, surgery or when a patient would be admitted. Codes used in medical billing are national codes that are used to assist insurance companies in their payment process. Specific guidelines are used to determine which code would be used for billing purposes.
Function
Medicare, Medicaid, hospitals, doctor's offices and medical insurance companies all use medical coding to understand bills that are rendered for payment. If a code isn't clear or doesn't match the treatment given to the patient, the claim may be returned or denied by the insurance company. Training in the field of medical billing and coding is specifically set up to learn the correct procedures for it.
Significance
To avoid medical insurance fraud, abusive practices and to control claims for medical necessities, medical billing and coding specialists are highly sought after individuals. The need for correct coding is a must in order for patients to be free of financial responsibility for their medical treatments, and in turn it is necessary for physicians and hospitals to have a high standard of billing and coding so they will be compensated for treatments given. When a bill is generated for a patient, a number (or code) is assigned to the treatment or visit and then the bill is submitted to the insurance company for payment.
Features
When a bill is created, patient information is entered specifying the person, their age, date of birth, address and contact information. The remaining information would consist of a diagnosis, treatment rendered and the length of the treatment or hospital stay. This is where codes are used. Each code is designated with a dollar amount for payment. Insurance companies have their own standards of payment structure and may not pay the entire bill, but will use the code designated on the bill to identify the treatment.
