Billing involves creating bills, also known as claims, to send to health insurance companies or patients. If a patient has health insurance, a medical biller sends claims to the insurance company. In this case, the insurance company will compensate the healthcare provider. If a patient does not have health insurance, medical billers send bills directly to the patient for compensation.
Medical billers and coders sometimes work together to create what’s known as a superbill, or an itemized form to create claims.
When a patient arrives at a hospital or other healthcare facility, medical professionals record the services, medications or procedures provided and the reason for each service. These details are what’s known as clinical documentation.
Medical coding involves analyzing clinical documentation and linking each service, medication and procedure with its designated code. Those codes, recognized within a standardized coding system, synthesize what providers did during a patient visit.
In most cases, one person can tackle both medical billing and coding, but the tasks are sometimes split between two professionals.
In the coding process, medical coders review physician notes, patient records, lab results and other clinical documentation. Medical coders assign standard medical codes to each service or diagnosis. These professionals then pass the codes to the medical biller who uses the codes to create claims.
Many medical billers and coders work for hospitals, physician’s offices, health insurance companies, law firms and public or governmental agencies. Some medical billers and coders work remotely, either as independent contractors or with a company. Most work full time.
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