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​​​​​​​What is Medical Billing?

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What is Medical Billing?
Medical billing is the process of submitting and following up on claims with health insurance companies in order to receive payment for services rendered by a healthcare provider. Medical billing translates a healthcare service into a billing claim. The responsibility of the medical biller in a healthcare facility is to follow the claim to ensure the practice receives reimbursement for the work the providers perform. A knowledgeable biller can optimize revenue performance for the practice.

Is Medical Coding the Same as Medical Billing?
No. The main responsibility of a medical coder is to review clinical statements and assign standard codes using CPT® (Current Procedural Terminology), ICD-10-CM (10th revision from the International Classification of Diseases), and HCPCS ( Healthcare Common Procedure Coding System) Level II classification systems. Medical billers, on the other hand, process and follow up on claims sent to health insurance companies for reimbursement of services rendered by a healthcare provider. The medical coder and medical biller may be the same person or may work with each other to ensure invoices are paid properly. To better understand what a coding transaction looks like, read the article "What Does a Medical Coder Do?"

What Do Medical Billers and Coders Do?
Medical billing and coding specialists are largely responsible for making sure medical office revenue cycles run smoothly. When a service is performed, a medical coder assigns codes to the services rendered. The diagnoses and procedure codes are taken from medical record documentation, such as transcription of physician's notes, laboratory and radiologic results, etc.

Although a medical biller’s duties vary with the size of the work facility, the biller typically assembles all data concerning the bill. This can include charge entry, claims transmission, payment posting, insurance follow-up, and patient follow-up.

Medical billers regularly communicate with physicians and other healthcare professionals to clarify diagnoses or to obtain additional information. The medical biller must understand how to read the medical record and, like the medical coder, be familiar with CPT®, HCPCS Level II and ICD-10-CM codes.

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