If you thought medical billing and medical coding were the same job, you're not alone. Many people use the terms medical biller and medical coder interchangeably, but they actually perform different functions. While some skills from medical billing can be applied to coding, they are two distinct roles. In this article, we will define what medical billing and medical coding are, discuss the personality traits suited for each role, provide an overview of the training required, and compare the Medical Coding and Medical Billing programs at ACC.
What is Medical Billing?
Medical billing involves submitting claims to insurance companies or patients for reimbursement. As a medical biller in a doctor's office or healthcare facility, your responsibilities include submitting claims, following up on unpaid claims, and disputing incorrect claim denials. Healthcare providers rely on medical billers to ensure they receive compensation for their services.
What is Medical Coding?
The term “coding” is commonly used within the context of technology and refers to computer programming. Medical coding, however, is a separate field with different objectives and undertakings. It is the process of translating medical treatments and procedures into a special language that computers and insurance companies understand. This language is made up of codes that represent different services and diagnoses. These codes are needed for billing, processing insurance claims, and keeping track of a patient's medical history.
What Do They Do?
Medical Coders
Medical coders translate the type of care provided to a patient into universally recognized alphanumeric codes. The job requires a deep understanding of medical terminology, coding guidelines, anatomy, physiology, as well as privacy and billing regulations within the healthcare system. Accuracy and precision are crucial since these codes directly affect billing and insurance claims.
Here are a few examples of real systems and codes used on the job.
- ICD-10 (International Classification of Diseases, 10th Revision): This coding system is used globally to diagnose conditions. For example, the ICD-10 code E11.9 represents type 2 diabetes without complications, illustrating how specific conditions are systematically categorized.
- CPT (Current Procedural Terminology): Employed in the U.S. to detail medical, surgical, and diagnostic services. An example of a CPT code is 71045, which is used for billing the radiologic examination of the chest; single view, highlighting how medical procedures are encoded for billing and documentation.
- HCPCS (Healthcare Common Procedure Coding System): This system includes codes for products, supplies, and certain services that are not covered by CPT. For instance, the HCPCS code J3301 is used to bill for an injection of triamcinolone acetonide, a corticosteroid used to treat inflammation, specifying the drug and dosage to ensure accurate billing and reimbursement.
Medical Billers
Once the medical coders have completed their work, medical billers use these codes to file insurance claims and post payments to accounts. The smoothness of this process largely depends on the accuracy of the medical codes. Billers handle claim appeals, prepare payment plans, ensure billing accuracy, and verify patient eligibility. This role requires strong communication skills and expertise in navigating insurance policies and regulations.
Personality Traits
Are you the outgoing type or are you the more technical type who prefers autonomous, task-focused environments? Your answer could determine which role you are more suited for.
Medical Billers
If you are a good communicator and enjoy working with people, a job in medical billing may be the perfect fit for you. Medical billers often interact with both patients and insurance companies to resolve any issues that may arise, requiring diplomacy and excellent customer service skills.
Medical Coders
On the other hand, if you prefer to work independently and are more comfortable with back-end tasks, you may find a career as a medical coder more appealing. Coders typically work alone, occasionally collaborating with other healthcare staff. They need to be analytical and detail-oriented, as their work doesn't usually involve extensive interaction with patients or insurance companies.
Medical Billing vs. Medical Coding Programs at ACC
ACC offers both Medical Billing and Medical Coding programs, designed to equip you with the skills needed for these careers. Here’s a closer look at the differences between the two programs:
Medical Billing Program Overview
Format: Online coursework with a 180-hour in-person externship for real-world experience
Program Length: Approximately 7 months
Prerequisites: High school diploma or equivalent
Certification Preparation: Certified Medical Reimbursement Specialist (CMRS) or Certified Professional Biller (CPB)
You’ll Learn:
- Medical billing procedures
- Claims processing and hospital billing
- Reimbursement and denial management
- Managed care and private health plans
- State and government health plans
Medical Coding Program Overview
Format: 100% online
Program Length: Can be completed in under 8 months
Prerequisites: One year of experience in healthcare or medical billing
Certification Preparation: Certified Professional Coder (CPC) or Certified Inpatient Coder (CIC)
You’ll Learn:
- Diagnostic coding
- Procedural coding
- PCS and HCPCS coding
- Medical terminology
- Applied coding and certification preparation
Why You Should Get Certified as a Medical Biller or Coder
Certification isn't mandatory, but it can significantly boost your career prospects and set you apart from other candidates. Getting certified opens doors to more career opportunities. Plus, ACC’s Medical Billing & Medical Coding programs prepare you for two different certifications, which means you’ll have the preparation you need to obtain these credentials.
Get the Training You Need for Success
Though medical coders and billers serve two different functions, both are essential for ensuring patients receive necessary care and healthcare organizations have the financial resources to operate effectively. Billers interact with patients and insurance companies, while coders work behind the scenes transforming raw data into useable information. ACC's comprehensive Medical Billing and Medical Coding programs will help you gain the job-ready skills you need to be successful in this field. Start your healthcare journey with ACC and explore our programs today.
