Medical billers and medical coders play two different but very important roles in the healthcare system. Often these two careers are grouped together, but they require two separate skill sets. If you’re confused about their differences, the following breakdown is a great place to start!
Medical coders tend to be more involved with the financial and technical side of the industry. Their job is to check patients’ medical records, test records, possible diagnoses, and notes from the patients’ physicians. The medical coder is responsible for assessing the procedures performed and the diagnosis, and using the information to decide the best diagnosis code for the situation.
A medical coder is in some sense similar to a translator. They need to take the information given to them, interpret it, and translate it into the most fitting and accurate code possible. Every different diagnosis and procedure has a different code– there are thousands of them! If at any point the medical coder isn’t sure of something, they are responsible for reaching out to the doctor of the patient in question and clarifying any issues. Once they’ve completed the “translation,” they send the code to the medical biller so they can complete the next steps.
Medical billers take over once the medical coder sends them the medical code. Unlike medical billers, coders interact and communicate directly with the patients. They receive the medical code, and then bill the patient. Sometimes a hospital or clinic requires authorization from a patient’s insurance carrier. If this is the case, it’s the medical biller’s job to call the insurers and get a guarantee of payment. Medical billers are client-facing, so they need to be able to answer any questions that patients may have about their bill.
That being said, medical billers and coders do share some similarities. Both normally work at clinics, hospitals, and pharmacies.
In some instances just one person will perform both medical coding and medical billing. This works best in very small organizations. Otherwise too much pressure is put on a single individual, which can lead to unnecessary stress and extra mistakes.
Medical billers and coders have their differences, but they also have much in common. Both do work behind the scenes but play a pivotal role in the everyday tasks of a healthcare facility. Patients can’t be recorded, treated, or billed properly without them!