Medical Coders vs Billers: What’s the Difference?

Medical Coders & Billers

Healthcare facilities rely on both medical coders and billers to keep revenue cycle management running smoothly. Though they work toward a common goal, these two roles come with distinct duties and requirements.

In this post, we will break down the key differences between medical coders and billers in terms of:

  • Responsibilities
  • Necessary skills and traits
  • Education and credentials

Defining the Roles of Medical Coders and Billers:

Before diving into the key differences between medical coders and billers, providing clear definitions of each role lays the necessary foundation. Both positions play integral parts in keeping revenue cycle operations running smoothly. However, their specific duties require very distinct skills, credentials, and day-to-day work.

What is a Medical Coder?

Medical coders are responsible for translating healthcare services, diagnoses, and procedures into universal medical code sets that convey essential details to insurance providers. This coding facilitates accurate billing and reimbursement. Key responsibilities include:

  • Reviewing clinical documentation from patient charts to understand procedures, diagnoses, services, etc.
  • Ensuring coded data is complete and consistent for maximum reimbursement.
  • Using training of medical terminology, anatomy, disease processes, and coding guidelines to select the most precise codes.
  • Meeting productivity standards and tight deadlines for code assignments.
  • Assigning accurate medical codes using classification systems like ICD (diagnosis codes), CPT (procedure codes), and HCPCS (healthcare services codes).

What is a Medical Biller?

Medical billers take coded documentation and handle the billing process from start to finish. This includes submitting insurance claims, tracking them to ensure payment, appealing any claims that are initially denied, and following up on unpaid claims. Key responsibilities include:

  • Verifying patient insurance eligibility and benefits to facilitate claim submission.
  • Preparing accurate insurance claims by pulling together essential documentation, codes, charges, etc.
  • Submitting claims to insurance carriers in a timely manner.
  • Monitoring claims progress through the adjudication process.
  • Appealing denied claims when appropriate to pursue maximum reimbursement.
  • Initiating collection efforts for outstanding payments on approved claims.
  • Analyzing explanations of benefits and payer rejections/denials to determine next steps.

Key Differences Between Medical Coders and Billers

As outlined above, while medical coders and billers work together to process healthcare services for payment, their day-to-day duties differ significantly.

Coders focus on abstracting the patient’s medical record, assigning accurate codes, querying physicians for additional documentation if needed, and ensuring codes meet compliance standards across state and federal guidelines.

Billers take those finished codes and handle all aspects of claims submissions, payments, rejections, appeals processes, collections, and maintaining patient accounts. 

Medical Coders vs Billers

Essential Skills and Personality Traits

Coders and billers also require some distinct skills and personal strengths to succeed, including:

  • Coders – Excellent attention to detail, medical terminology expertise, analytical skills, fast learning ability.
  • Billers – Organizational skills, customer service abilities, communication skills, problem-solving acumen.

Education and Certifications

Finally, breaking into either role also follows different education and credentialing paths:

  • Coders typically pursue a medical coding certificate or associate’s degree related to medical coding. Obtaining certified professional coder (CPC) credentials is also generally required.
  • Billers often complete a certificate or associate’s degree focused on medical billing and coding. Having a certified billing and coding specialist (CBCS) certification is also considered standard practice.

The Takeaway

Medical coding and billing are complementary disciplines that keep healthcare reimbursement operating smoothly. Coders categorize patient encounters. Then billers use those codes to properly bill out and obtain payment for the provided services.

Though they work hand-in-hand, at their foundation coders and billers perform quite different daily functions and require unique skillsets to excel. Understanding those distinctions helps healthcare employers staff their revenue cycle teams most effectively.

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