What Is the Relationship Between Medical Billing and Medical Coding?

Even though medical codes are part of medical billing, the roles differ. Coders work behind the scenes, while billers interact directly with staff and patients.

As recently as 2017, American households spent a total of almost 980 billion dollars in medical bills throughout the calendar year, according to PBS News Hour. That comes to about $3,200 per person.

Secondarily, Americans ended up paying a total of 1.7 for other healthcare costs by way of state and federal taxes which is mostly is to help cover Medicare and Medicaid.

Medical billing and in tandem medical coding are a big part of how these costs are calculated and determined. Keep reading to learn how the relationship between the two works and why one can’t work without the other.

Medical Billing

Medical Billing is an important part of the American healthcare system. Healthcare facilities use it to determine how much to bill a patient and their insurance company.

The Medical Billing process happens when a person is billed for an office visit or treatment. The medical billing process and procedure is pretty much uniform across the board for all medical or healthcare facilities.

To put it in more professional terms they use the same coding, booking, and billing procedures.

But, there will be some differences in wording when it comes to emergency rooms and hospitals compared to small or family doctor’s offices.

Medical Coding

Medical Coding is the numerical or alphanumeric code for each illness or diagnosis made by a physician or nurse. This is written down in the billing process and it tells the insurance company why the patient was in the doctor’s office or hospital.

Each injury or illness has its own specific code and each code has a price that accompanies it. This, in turn, is what determines how much the bill will be for the insurance company, patient, or both.

The best way to think of the relationship between Medical Billing and Medical Coding is that you can’t have one without the other.

As far as the different types of diagnosis codes there are, they can be anything from upper respiratory illness, ear infection, and sore throat, among others.

There are also procedure codes which can be anything from an office visit, a shot of Penicillin, or stitches.

Medical Billing and Coding RegulationsIn

In the United States regulations rule the world, especially in the medical world. You hear doctors and nurses alike often complain about how red tape and regulations get in the way of them going their job and actually helping people.

Just like any other business, the healthcare industry has to comply with both state and federal regulations to avoid being sanctioned or shut down entirely.

But, healthcare facilities have more regulations than other businesses because they not only deal with the business or financial side of healthcare but they also are responsible for the well-being of each individual.

On a national level, the CDC and CMS Center for Disease Control and Centers for Medicare and Medicaid Services regulate the medical industry.

How Are Coding and Billing Different?

Medical coding and billing are often thought of as the same thing. But, as you can see above they aren’t the same They work in tandem to help healthcare businesses and insurance companies understand who owes what and how much.

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Author: Mike Cynar

Mike Cynar brings buyers and sellers together by producing reviews and creating non biased webpages allowing users to share their experiences on various products and services. He and his staff write informative articles related to the medical field, legal, and other small business industries.