Medical Billing vs. Medical Coding: Navigating the Distinctions

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In the world of healthcare administration, two roles often intertwined are those of medical billing and medical coding. Although they work together to ensure the financial well-being of healthcare providers, it is essential to understand the distinctions between these roles, especially if you’re contemplating a career in either profession.

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Considering a Career in Medical Billing or Coding?

If you’re drawn to a career in healthcare but are unsure about the specifics of medical billing and coding, this article will shed light on these roles. To make an informed decision, it is crucial to understand what medical billers and coders do, where they work, and their earning potential.

Are Medical Billing and Medical Coding Identical?

No, medical billing and medical coding are not identical, as the American Academy of Professional Coders (AAPC) reports. While both play vital roles in the healthcare reimbursement cycle, they are distinct professions, often carried out by separate individuals. However, in some cases, the same person may handle both coding and billing responsibilities.

Due to their close partnership in healthcare, educational programs frequently combine these two topics, offering students a comprehensive view of how they function together. Some educational programs even provide combined courses that include medical coding, billing, and medical terminology & anatomy.

If you choose to enroll in a medical billing or coding course, consider a reputable organization, such as AAPC, AHIMA, or CCO (Certification Coaching Organization) for quality training and support.

What Medical Billers Do

Medical billers are responsible for processing insurance claims to ensure healthcare providers receive payment for their services. They utilize specialized medical billing software to create claims after the codes have been input into the system. Additionally, they engage with patients, healthcare professionals, and insurance carriers to facilitate payments.

Medical billers may also be the point of contact with insurance carriers to secure authorization for specific medical procedures. They follow up on overdue invoices by contacting patients, forwarding claims to collection agencies, and appealing denied claims. Furthermore, they educate patients about deductibles, copays, and other insurance plan requirements.

What Medical Coders Do

Medical coders decipher the details of a patient’s medical encounter, translating the information provided by physicians into standardized medical codes. For every diagnosis, treatment, or procedure, specific codes are assigned to ensure accurate reimbursement.

These codes are drawn from national classification systems such as ICD-10-CM, CPT, and HCPCS in outpatient settings and ICD-10-CM and ICD-10-PCS in inpatient settings. Reporting accurate codes based on physician documentation conveys the medical necessity of the services provided. If any doubts arise about the documentation, coders discuss it with staff members or query the physician.

Where They Work

According to AAPC, medical billers and coders work in a vast number of different settings:

Physician offices
Hospitals
Ambulatory surgery centers
Urgent care clinics
Sports medicine clinics
Mental health practices
Hospices
Telehealth providers
Collection agencies
Risk adjustment vendors
Insurance companies
Professional liability companies
Federal government agencies
And many other settings

Working From Home

Many aspiring professionals wonder if they can work from home in medical billing and coding. The answer is a resounding yes. In fact, AAPC asserts that 55% of medical records specialists work remotely. Historically, only the most experienced billers and coders were allowed to work from home, but the COVID-19 pandemic changed that when many billers and coders transitioned to remote work in early 2020, and a significant percentage continued to do so in 2021.

This technological progress suggests that even entry-level coders may encounter more telecommuting opportunities in the future.

Earnings

Medical billing and coding are complex professions that command respectable salaries and a crucial aspect that many aspiring professionals consider. Earning potential is based on the level of certification and years of experience. The following sources provide their findings regarding the earnings of medical billing and coding professionals.

U.S. Bureau of Labor Statistics

According to the U.S. Bureau of Labor Statistics, as of 2022, medical records specialists, which include medical coders and billers, reported a median annual salary of $47,180 or approximately $22.69 per hour. The field shows promising growth prospects, with a projected 8% increase in job opportunities expected through 2032.

AAPC Salary Survey Insights

AAPC conducted a survey that illustrated salary trends within the medical billing and coding industry. Their 2023 Medical Coding and Billing Salary Report, for instance, offers valuable insights into the earning potential for certified and noncertified professionals.

Certification plays a pivotal role in determining the earning capacity of medical coders and billers. According to the AAPC report, noncertified medical record specialists have an average income of approximately $46,321 annually. In contrast, those who hold relevant certifications tend to earn considerably more. Certified medical records specialists, on average, earn around $56,290 annually, with the potential for even higher earnings with each additional certification they acquire.

Moreover, the type of certification can further impact earnings. For instance, Certified Professional Billers (CPBs) report a median annual income of $56,981, while Certified Professional Coders (CPCs) earn slightly more, with a median annual income of $58,895.

AHIMA’s Survey

As of our most recent research, AHIMA (American Health Information Management Association) has not provided an up-to-date salary report for health information technicians and medical coders since 2019. While this information may not be current, it’s worth noting that in 2019, the outlook for health information technicians and medical coders was optimistic. During that time frame, a growth rate of 11% between 2018 and 2028 was anticipated, highlighting the consistent demand for professionals in this sector.

For detailed information, refer to the respective surveys.

Conclusion

Medical billing and coding are pivotal to healthcare reimbursement, albeit distinct professions. By understanding the roles, work settings, and earning potential, you can make informed decisions about your career path. With the promising outlook for salary increases and telecommuting opportunities, pursuing a career in medical billing and coding is a wise choice. If you decide to pursue this path, consider courses from reputable organizations for the best training and support.