Medical Billing and Medical Coding… What’s The Difference?

Working in tandem, medical billing and coding translate your doctor’s visit into languages that form the claim that is submitted for the purpose of reimbursement. The processes are separate, but both are pivotal for the practitioner to receive payment from the insurance company of the patient. The entire process of medical billing and coding begins when a patient registers and ends when the provider receives full payment for services rendered. The cycle takes anywhere from a few days to months, this usually depends on the nature and complexity of services, how the claims are managed and processing of any denials, followed by the collection of the insurer and patient payments.

Medical Coding is the art of extracting billable information from a medical record or clinical documentation. This process begins when a patient encounters a provider in a medical office, hospital, or other healthcare facility. The practitioner details the services and the visit in a patient’s medical record. They offer explanations for why certain services, procedures, or items were performed. The provider uses this clinical documentation to explain, or justify, their reimbursement to payers, in the case of a conflict arising with the claim. This is a slippery slope for providers, as they can be subject to a healthcare fraud or liability investigation for billing payers and patients for incorrectly documented services. Once the patient leaves the provider, their medical record is given to a coder who uses one of the varied codes, ICD-10 Diagnosis Codes, CPT and HCPCS Procedure Codes and Charge Capture Codes, Professional and Facility Codes, to submit the claim to the insurer.

Medical Billing uses the codes, created in the coding phase, and creates insurance claims and bills for patients. This part of the process begins at patient registration in the doctor’s office, hospital, or medical facility. It could also begin when the patient schedules an appointment. At check-in the patient confirms their provided information through required forms, providing the groundwork through which claims can be billed or collected most effectively.

At this point, patients give their co-payment, when applicable. In this instance provider’s staff should also confirm the patient’s financial responsibility. This portion also contributes to the coding process, as it begins the process for what is added to the medical record. Billing is key to generating a profit for your practice. Clean claim submission is Gables Medical Billing’s priority, confirming the cleanliness of our claims is also something we have the knowledge and follow-up regimen to ensure for your practice.