How Does Medical Billing and Coding Work?

by Applied Medical Systems

When a patient undergoes a procedure or medical exam, the medical facility will collaborate with the patient and his or her insurance company for claims. The medical biller will submit the claims in order to collect payment for the services provided by the healthcare practice. Claim submission involves learning a large amount of claims that each represent a symptom, medication, or diagnosis. Therefore, medical billing and coding professionals need to go through extensive training to be successful at submitting claims that pay healthcare providers. The main goal of medical billing and coding professionals is to process insurance information, treatment records, and other types of patient data. They are responsible for coding the diagnosis of each patient and requesting payments from his or her insurance company.

Medical Billers vs. Medical Coders

It’s important to note that medical billers and coders are two separate jobs. The size of the organization will determine whether medical billing and coding roles are separated or blended together. Medical billers must make sure that every patient is being billed correctly by communicating with patients and/or insurance companies to ensure that invoices are paid in a timely fashion. They need to demonstrate great amounts of patience as working with sick, stressed, or contagious patients can be challenging. Medical coders have a thorough understanding of coding language and are proficient at interpreting medical invoices. While medical billers interact heavily with patients and insurance companies, medical coders spend the majority of their time assessing and coding data. Medical coders must make sure all data is properly coded so that the revenue cycle of a medical facility runs smoothly.

In-House vs. Outsourced Medical Billing and Coding

Some medical billers and coders work in an office setting, directly for a medical organization. While some work part time, most in-house medical billers and coders work a standard 40-hour work week. Other medical billers and coders work for a company that provides outsourced medical billing and coding services to a wide variety of medical practices.

Highly-Trained Medical Billing and Coding Experts are Available at Applied Medical Systems

At Applied Medical Systems, we specialize in both medical billing and coding. We use the most advanced technology-driven solutions to produce claims that are paid with minimal denials, offering expedited cash flow for medical practices across the country. For more information on our medical billing and coding services, contact us today.