Top 10 Differences Between Medical Billing and Medical Coding

Differences in Medical Billing and Medical Coding

Healthcare organizations focus differently on medical billing and medical coding due to the varying scope of their tasks and functions. However, both processes are key factors in driving your revenue cycle and must be optimized.

This blog will be focusing on ten differences between your coding and billing processes. We will also analyze how they collectively influence the job dynamics of your staff employees working as coders and billers.  

Differences Between Medical Billing and Medical Coding

10 Differences in Medical Billing and Coding

Medical billing and medical coding are two distinct processes implemented by healthcare organizations. Both of them have a range of differences based on the organizational operations and outcomes for which you implement them.

The differences are based on jobs, knowledge, patient interaction, organizational sizes, and autonomy. These processes can also be different in terms of their requirements, salary ranges of the relevant staff, and many more functions.

    1. Job Roles

Medical coding services require coders to validate the records of the healthcare services availed by your patients. They use these records to assign specific codes to those specific healthcare treatments and procedures. 

On the flip side, medical billing involves billers who have to submit reimbursement claims to insurance companies. There are specific claims that correspond to specific medical services provided by healthcare organizations.

In this way, you use medical billing solutions to collect payments from your patients for those services. At the same time, you must implement top medical coding standards to assign appropriate codes to them.

    2. Knowledge Required

The knowledge required to effectively execute the medical coding and medical billing processes is also different. Your billers should possess comprehensive knowledge of the latest regulations and coding conventions. 

They should also be able to work fast and timely to meet deadlines. This requirement is important as you always have a large volume of medical bills that must be promptly managed. Moreover, medical coders must be thoroughly familiar with a wide range of medical terminologies.

Your coders should also be highly skilled in computer-assisted coding. It is a new medical technology that can code your services more accurately and efficiently. You can also use natural language processing to extract healthcare data from your records through this technology.

    3. Patient Interaction

Your medical billers and coders also have to interact differently with the patients. The coders primarily deal with their data and do not interact much with them. They tend to work with details like demographic entries and medical treatments availed by your patients.

In this way, medical coders use that data to appropriately assign the relevant codes so that you can accurately process reimbursement claims. These practices are significantly different from medical billers, who are more likely to interact directly. 

They have to regularly work with patients to make them understand your process of collecting payments for the medical services they avail. Effective communication is key for billers as they have to communicate sensitive aspects of healthcare work.

    4. Organizational Sizes

The difference in both processes also depends on the size of the organizations in which your staff is working. Your medical billers and coders are more likely to work separately with different responsibilities if your healthcare organization is set up on a large scale.

In contrast, small-scale hospitals or clinics share the responsibilities for both processes, and their staff usually works together. A large organization also incorporates varied training for its staff based on the contrasting skills required and responsibilities.

Their coders are mostly out of sight as their work does not require much interaction with the data already collected. If you run a small healthcare organization, your coders and billers may work closely to collect information and deal with patients.

    5. Autonomy

The degree of autonomy also differs with which medical coders and billers work. Your billers may work independently due to the straightforward dynamics of their work. They interact with patients and prepare reimbursement claims accordingly for payment posting.

Furthermore, you may find your medical coders discussing various aspects of their work with other staff members. This difference is caused by the industry standards set for medical codes, due to which coders must be familiar with their diverse range of different treatments.

    6. Job Requirements

Medical billing and coding jobs also have varying requirements for prospective applicants. You can appoint staff members who qualify for their open positions and have fulfilled those job requirements.

Most billing vacancies require an associate degree at least as it fulfills the minimum level of skills and expertise required. At the same time, you may hire medical coders if they have completed a considerable number of relevant certifications from accredited authorities.

This distinction is applicable as coding jobs largely require specific training for new coders. It is helpful for them to become familiar with the coding conventions. Billers and coders also have to pass different exams to gain the qualifications required for practicing their jobs.

    7. Salary Ranges

In addition, you can allocate the salary ranges of your medical billers and coders based on their different job responsibilities. In that regard, the salary range of medical billers is likely to be slightly more than that of coders.

Your healthcare organization may require its billers to take on specialized tasks and implement customized techniques to deal with your patients. Each case is different from the rest, and medical billers have to be flexible in their work approach.

Apart from this, the salary of medical coders tends to be on the lower end since their work responsibilities involve direct measures. Analyzing health records of patients and appropriately assigning codes comprise relatively easier tasks to maintain efficiency.

    8. Additional Skill Set 

Both of these processes require an additional skill set to be incorporated into their respective jobs apart from the technical skills. For medical coding, you have to manually handle data for a large amount of time. You must also maintain its accuracy in terms of different medical codes. 

Therefore, your medical coders must be extremely self-disciplined and attentive to detail. These general skills are important as they can save healthcare facilities from revenue loss. In comparison, medical billing requires another general skill set to deal with your patients.

Its staff spends more time on phones as they have to regularly communicate with patients and their insurance companies. As a result, they should have excellent problem-solving and communication skills. These skills will facilitate their roles, like managing insurance coverages.

    9. Job Prospects

Future job prospects also matter a lot, specifically for medical fields like billing and coding. Both processes have contrasting projections, which can vastly impact the work dynamics of your staff. Current market trends suggest that the medical coding process has better job security.

Medical coders are considered specialists in terms of healthcare records. You must have noticed the growth in this process due to a constant rise in new medical treatments and procedures. An increase in work directly correlates to more jobs for the relevant professionals.

On the other hand, medical billers have been constantly experiencing a decrease in their job security even after fulfilling their requirements. Consistent increase in workload and lack of flexibility has pushed professionals to branch out and explore other job prospects.

    10. Organizational Framework

The organizational framework of medical billing also differs from that of medical coding. In medical billing, you have to follow up with your patients and their insurance providers. You do this to confirm the payments of your reimbursement claims.

On the other hand, medical coding solutions are largely based on entering the billing data through specific medical software. The software primarily used in healthcare organizations are named Electronic Health Record (EHR) and Electronic Medical Record (EMR).

The Bottom Line

This blog highlighted a wide array of ways in which medical billing can be different from medical coding. We specifically covered the contrast in both processes in terms of job dynamics and organizational operations.

Our RCM solutions are expertly well-versed in all the ins and outs of billing and coding processes. Join us today and stay informed on how to effectively implement them by navigating through their different functions.

Frequently Asked Questions (FAQs)

    1. What is the difference between medical billing and medical coding?

Medical billing involves interacting with patients to generate their medical bills and prepare reimbursement claims. In contrast, medical coding deals with patient data to assign codes to the healthcare services availed.

    2. What are the different types of billing and coding?

There are five types of billing and coding that comprise ICD-10-CM, HCPCS Level II, ICD-11, CPT, and ICD-10-PCS. Current job openings usually prefer an expert grasp of all these types by their applicants.

    3. What is the hardest part of medical billing and coding?

The hardest part of medical coding is working with the diverse range of medical codes that have to be assigned. These codes are regularly updated depending on the new changes in healthcare treatments and procedures.

The most difficult aspect of medical billing is when billers have to work with patients. Billers have to consistently make them understand the technical aspects of their reimbursement claims, which can be tough.

    4. What is the use of medical coding?

Medical coding is used to ensure that healthcare organizations accurately generate medical bills for patients and file reimbursement claims from their insurers. 

This practice relies on specific codes assigned to different medical services, which are set by industrial guidelines and standards.

    5. What is medical coding with an example?

Medical coding is a process in which complex healthcare procedures and diagnoses are translated into universally understandable codes. These codes are standardized in the healthcare sector and can be accurately interpreted.

An example of medical coding is administering a flu shot to your patient. This particular medical service is assigned 90658 as its standardized code.


Leave a Reply

Your email address will not be published. Required fields are marked *

Call Us

Start Your Free 15 Day Trial Now!

Are you uncertain about the potential benefits our customized solutions can bring to your healthcare business? Why not give our Revenue Cycle Management (RCM) solutions a try? For the first 15 days, it's absolutely free! Witness the transformation we can bring to your medical billing operations.

Schedule a meeting!
Skip to content