Showing posts with label Billing. Show all posts
Showing posts with label Billing. Show all posts

Medical Billing And Coding Jobs: The Importance Of Understanding The Difference

Medical Billing And Coding Jobs: The Importance Of Understanding The Difference

It is often assumed that medical billing and coding jobs are one and the same, however, in actual fact the two functions, both of which are crucial to the smooth operation of a medical practice or medical facility, are quite different in nature. As a result, top notch billers and coders are highly valued and highly respected.

Individuals just entering the field of medical billing and coding, and seeking medical billing and coding jobs often wonder if both jobs can be performed at the same time, and the suggestion is generally not. Initially it is preferable to focus on either medical billing or medical coding as the training on and off the job can be intense. Naturally, being qualified and experienced in both areas improves a prospective employee's marketability and in turn, level of earnings, however, it is advisable to "walk before you run" - so to speak.

I will now provide a brief overview of each position and expand on a few of the basic job duties and look at some of the beneficial skills. The intent is to assist the reader in choosing an specific area when seeking medical billing and coding jobs.

Medical Billers

Depending on the size and scope of the medical practice or medical facility, the role of a medical biller can vary, however, in basic terms, they are responsible for managing the accounts receivables. In other words, the primary role of a biller is to ensure that the employer gets paid or reimbursed in a prompt manner.

A medical biller position is typically a 9 - 5 - five day a week type position, and is considered an accounting or administrative function. They must be proficient in typing and working with computers, particularly with Excel spread sheets, database management software programs, and medical practice accounting software.

Further, a basic understanding of medical law, medical ethics, and medical terminology is a must and is generally acquired through formal training and certification. Although medical billing and coding jobs are quite different, some exposure to medical coding is beneficial.

Most of the highest paid medical billers possess strong communication skills. Although administrative in nature, much of the role involves resolving complex issues, explaining insurance details, collecting overdue payments, and structuring repayment schedules. As a result, it is important to develop good rapport with patients, health insurance providers, doctors, other staff members, and other departments within the organization.

Medical Coders

The role of the medical coder, on the other hand, is to ensure that the proper medical codes are assigned to insurance claims submitted to healthcare insurance providers.

The process is broken down into three areas, the patient visit which is referred to as a "patient encounter" or simply "encounter", the diagnosis, which has associated with it an ICD code, and the services rendered, which has associated with it a CPT code. A medical coder must ensure that the codes are correct prior to submitting the claim forms, otherwise, reimbursement will be delayed.

A good coder must possess a strong attention to detail and have some perfectionist attributes. A basic understanding of medical terminology and a grasp of the requirements, policies, and procedures of major healthcare insurance companies are a must. In addition, a good memory and the patience to scan through coding is helpful.

In summary, although there is some overlap, medical billing and coding jobs do differ in terms of the basic job functions as well as the skill requirements. A medical biller role encompasses more interaction with people while a medical coder role is more behind the scenes. Assess your strengths, weaknesses, skills, abilities, and general personality type, and then make a decision as to which position would be the best fit for you.


Diagnostic Code Scanner - Medical Billing And Coding Jobs: The Importance Of Understanding The Difference

Stay Away From 'Double Billing' When Engaged in This Radiology Procedure

Stay Away From 'Double Billing' When Engaged in This Radiology Procedure

After suffering a blow to the head, a patient showed the following symptoms - dizziness, sleepiness, slurred speech, and confusion. The doctor attending to the patient ordered a CT scan to check for internal injuries and aneurysm. After finding out that there was no evidence of serious injury, the doctor admitted the patient for observation.

Under such circumstances, can the physician biller bill for the interpretation?

The answer is no. The physician biller cannot bill for the interpretation. A facility radiologist or other physician may give interpretations for all ordered tests as a matter of policy in a hospital or other inpatient facility. As such, you being the admitting but not attending/ordering, physician's biller, you are not entitled to reporting the interpretation for 70460.

You need to ensure that only one person reads the diagnostic test and the person billing it should have an all-encompassing report. If your physician reads the films/fluoros and bills for them, then you should keep handy a separate note with a separate signature at the end of the op.

You probably could not report the CT scan interpretation for your doctor in the above scenario because, very likely, the hospital radiologist would prepare the initial report for the CT scan. Even when your doctor provides the immediate interpretation used for treatment and the radiologist provides an "over-read" (secondary quality assurance review), hospital rules may give the charge to the radiologist.

Conclusion: So if one physician has already interpreted a test and provided a report outlining the result, no other physician can bill for the same service. This would fall under the category of radiology procedure double-billing.


Diagnostic Code Scanner - Stay Away From 'Double Billing' When Engaged in This Radiology Procedure