What is Medical Coding and Billing? (Part 3)

If you’ve read part one and part two of this blog series, you’ll have a good idea of what medical coding is and why it’s so important. Now let’s cover the difference between a medical coder and biller in this third (and final) part of the series.

Medical Coding vs. Billing

There is a monumental difference between a medical coder and biller. While medical coding and billing goes hand in hand and a lot of times when it comes to training, in the real world they’re separate. You have the coders over there in that department and billers over here in another department. Also, they don’t tend to pay the biller the amount of money that they pay the coder because at the end of the day, the coder achieves maximum reimbursement for the service or procedure. That’s where the money is and that’s why coders are so important.

Once coders do the time-intensive, highly manual part of identifying and building codes, then checking them for accuracy, they hand these codes off to the billers. Well, the billers will jump on to whatever billing software that company is using enter the codes that the codes that you’ve chosen find the appropriate insurance company, click on it, hit submit and off the claim form goes electronically. Within a couple of days, that the paycheck is produced, but the doctors is then paid for his or her services because of the work of the coder.

The Importance of Coding Credentials

It doesn’t take a rocket scientist to know which of these jobs is easier, which is oftentimes why companies have no problem hiring a biller off the streets and paying them $13-14 an hour. It doesn’t require any kind of credentialing or education. If I were the one running the show at your doctor’s office, your clinic or your hospital, I would never ever hire a biller that was not certified or not mastered in coding guidelines because the fact of the matter is that two heads are better than one.

Let’s say that you’re at your doctor’s office and there’s only two of you and one of you is the coder the other one is the biller. It would make sense that both of you code and both of you exchange your codes with each other and the end of it all, one of you audits the other. When you do that you, you’ve lowered the number of potential mistakes. The coder will sift through and say, “Oops, nope, that’s not the actual code. This is the better one.” Or maybe you need to append a modifier. It sometimes takes two and two heads are better than one, so that’s why coding credentials are important.

It’s All About Education

I’m giving you this information to help you educate those who are interviewing you; to help educate your managers; to help educate your doctors. They don’t know this information. Oftentimes, they’re too busy running operations they’re too busy performing surgeries. It’s not common knowledge, folks! So educate them (with all due respect) and they’ll see the value of medical coding and medical coding certifications/education.

There you have it! Hopefully by now you know the answer to the golden question: “What is the difference between a medical coder and medical biller?”

Editor’s note: This post was originally published in March of 2019. It has been updated for accuracy and clarity.