Do medical billing and coding overlap?

medical billing and coding overlap

How does medical billing work?

Medical billing is actually the process of creating insurance claims for healthcare services that are provided by providers and provider organizations with the goal of getting payment. The medical biller specifically tracks the claim after making a conversion where a healthcare service is converted into a billing claim to ensure the organization is actually paid for the work the provider completed. A professional medical biller can boost revenue generation for the doctor's office or medical facility.

Is medical billing the same as medical coding?

Coding and billing for medical services are actually two separate but connected processes. However, both are essential to the healthcare industry since they inform commercial and government payers like Aetna and Medicare about diagnoses, treatments, and supplies.Medical coders and billers must be conversant in medical jargon, anatomy, and pathophysiology to comprehend doctor's notes and operating room reports since they collaborate with clinical staff. Medical coders sometimes work for billing companies and participate in the billing process. It's, however, not unusual for the same person to properly work as a medical coder and a medical biller in small physician practices. Although billing and coding are different, they play crucial roles in the healthcare revenue cycle.

What Do Health Care Coders Do?

A medical chart is maintained each time a patient sees a clinician for medical treatment or evaluation. Medical coders review the patient record and collect information that can be billed, which they convert into standardized codes. Procedure codes inform the payer of the service rendered. It diagnoses codes to inform the payer about the patient's reason for receiving the services.Medical coding and billing intersect at the standardized codes used by medical billers to generate insurance claims and bills for patients.The medical billing cycle, however, starts before medical coding and finishes once the doctor or healthcare facility has received all reimbursements due for the medical services provided.

Functions of Medical Billers?

To make arrangements for the payment of medical services, medical billers coordinate with patients, healthcare providers, and insurance companies (also known as payers). Billers first gather the essential data. Demographic information, medical history, insurance coverage, and therapies that the individual has had are all included in this.Billers must check patients' insurance plans and medical data to ensure that the services they are billing for are covered. The next step is for professionals to create and submit medical claims to payers after verifying their veracity. Once payers have approved the claims, the billers receive the agreed-upon sum back.

Billers are now preparing the patient's bill before the patient visits the doctor. This entails subtracting the portion of the surgery or service paid for by insurance, accounting for copays and deductibles, and adding any unpaid patient balances. Patients receive invoices when necessary, which are posted and reconciled with the payments. But much more goes on in a healthcare biller's workday before, after, and between.


The need for highly skilled, highly professional medical billers has increased due to growing reimbursement challenges in the healthcare sector. There is a strong demand for professionals familiar with medical insurance, reimbursement procedures, and the claims process. The nation's leading medical coding and billing training and certification organization, Intellimedx, offers numerous training alternatives if you're planning on becoming a qualified professional medical billing organization.