There’s a reason why the job outlook for medical billing and coding jobs is expected to increase by 9% over the next decade. We rely on these professionals to mediate the financial operations in a healthcare facility.
However, whether you’re in the industry, or a patient, understanding the nature of medical billing and coding can be tough. That’s why we made this article.
In it, we’ll go over some medical billing and coding examples and definitions. That way, you better understand their important function in this industry. Let’s get started!
What Is Medical Billing?
Medical billing is the financial arm of the healthcare industry. These professionals are in charge of filing insurance claims and submitting payment amounts to patients’ accounts.
However, that’s far from the only thing that a medical biller needs to do. They also must:
- Review all relevant medical records
- Identify any diagnoses or procedures done to the patient
- Relay information to either insurance carriers or government agencies
You can think of them as a liaison between the patients and their respective insurance providers.
Medical billers also work in tandem with medical coders to translate the codes that they create. However, we’ll go more into that in the next sections.
What’s An Example of Medical Billing?
You can break medical billing into front-end and back-end roles. Let’s first take a look at the front-end process. This starts when a patient schedules an appointment.
The medical biller will be responsible for registering the patient. That means collecting information about their symptoms, medical history, and insurance coverage.
This information must be correct because it lays the groundwork for the entire claims process. Before the appointment, the biller will make sure that the patient’s insurance covers the treatment their seeking.
They’ll also submit a pre-authorization so they know that the healthcare provider will be reimbursed for their services. The front-end medical biller will also need to convey information to the patient.
Specifically, things like the max amount of visits they can have and any cost responsibilities they’ll be responsible for. If the patient can’t afford their treatment, then the medical biller will also help them find a payment plan that works for them.
After the treatment is done, the medical coder translates everything into codes. It’s then the job of the backend medical biller to create, submit and manage any medical claims with the insurance company.
First, they’ll need to translate everything provided by the medical coder. Once this is done, they can proceed with assigning a price to everything.
Then, they submit this information to the payer, whether that’s an insurance company, government agency, or the patient.
If claims processing is rejected or denied, then it will be up to the medical biller to mediate between the insurance company and the patient.
What is Medical Coding?
Medical coding is the process of translating what happens at a healthcare facility into a universal medical code that can be understood by others in the industry.
What types of things do they need to translate. Typically, you will see medical coders working with:
- Diagnoses
- Procedures
- Supply information
Unlike medical billers, medical coders don’t interact with patients in the healthcare industry often. That being said, they do need to have in-depth knowledge of both medical terminology, patient records, and code procedures.
Since they’re collaborating with the medical billers, they also need knowledge of how healthcare billing typically goes.
What’s An Example of Medical Coding?
Now that we know a little more about medical coding let’s take a look at an example of how it looks in a real hospital. In this example, the medical coder receives a medical record regarding a patient’s appendectomy.
It’s their job to translate this record — including the indications, procedures, and any medications used — into usable codes for the healthcare facility. First, they will identify what was performed by the doctor.
In this example, the doctor removed an infected appendix from the patient. Then, they’ll note how the procedure went and whether there was anything abnormal.
Finally, they’ll write down any medication used during the procedure, like sedatives. Once they have all this information they will then translate it into relevant CPT medical codes.
CPT stands for Current Procedural Terminology and knowing it is an important part of medical coding training. In addition to this, they also need to be familiar with human physiology and other terminology.
At the end of the task, the medical coding will be left with a seven-digit number. This number will represent both the steps and supplies used in this specific procedure.
Where to Find Medical Billing and Coding Help
If you’re a Federally Qualified Healthcare Center (FQHC) or a Community Health Center (CHC), then you might be struggling to find medical billing or coding help.
This is unfortunate because, as you can see, these professionals are vital for smooth healthcare operations. If you operate out of California, then look no further than these FQHC billing services.
They provide you with a team that has thirty-six years of industry experience. On top of that, they also help with financial reporting and credentialing.
So, if you’re ready for the strategic partner that your healthcare facility deserves, then make sure to contact them or someone similar.
Appreciate These Medical Billing and Coding Examples? Keep Reading
We hope these medical billing and coding examples helped you better understand what these job positions do.
Whether you work in the healthcare industry, or you’re a patient, it’s essential to understand the function of these services.
That way, you can better navigate the information-dense healthcare environment. Did you appreciate this article? If the answer is yes, then keep reading to find more content just like it.
