Medical Biller v Medical Coder
Summary:
This brief guide gives Clinic Managers, Doctors, and Medical Groups a quick snapshot at the differences between Medical Billing and Medical Coding to they can easily identify which type of person they need to achieve higher approvals, the reduction of denials, and possible softwares that can help them get paid faster.
Medical Billers v Medical Coders Introduction:
In the healthcare industry, medical billing and coding are two essential functions. Medical billers submit claims to insurance companies and follow up on payments, while medical coders assign codes to diagnoses and procedures. Both roles are important in keeping the revenue cycle flowing smoothly. Here's a closer look at the difference between medical billers and medical coders.
Duties of Medical Coders & Medical Billers
The job responsibilities of a medical biller and a medical coder are two entirely different roles in the healthcare field. A medical biller's main objective is to review claims, submit them in a timely manner, and handle denials and appeals. Whereas a medical coder analytically reviews patient information and diagnoses to help ensure accurate billing by assigning codes from various classification systems such as ICD, CPT, or HCPCS which support claim submission. Both involve managing finances but the roles vary drastically when it comes to the actual duties; medical billers deal with all matters directly related to insurance companies and reimbursement for services, while medical coders serve as liaisons between physicians, patients, corporate payers, and insurers.
Educational Requirements of Coding v Billing
A Medical Biller or Medical Coder might seem like similar titles on the surface, but they can have different educational requirements. A degree is not always necessary for a Medical Biller, while a degree or technical college degree may be preferred by employers for a Medical Coder. In addition to a degree, those looking to pursue professional certification as a Medical Coder must have a certain number of hours of experience with the subject. The cost associated with the degree and certification can vary widely depending on various factors such as location and course credits required. Ultimately, the degree path or certification route is completely up to you; however, it is important to consider your career goals before making an investment in order to select the appropriate degree/certification for you!
Salary Expectations of Billers v Coders
When considering salary expectations for medical billers and medical coders, it is important to factor in hourly salary, benefits offered, employee retention rates, succession planning costs, and the associated costs of hiring and training new employees. Medical billers and coders play an important role within the healthcare system by ensuring proper payments to physicians and other healthcare workers. An hourly rate that adequately reflects the value of their work as well as benefits that promote employee retention will ensure that they feel valued while keeping associated hiring and training costs low. With a clear succession plan, businesses can save on recruitment expenses while ensuring a steady flow of qualified medical billers and coders for years to come.
As of January 2023, Medical Billers nationwide are receiving $15-$25 per hour ($31,200 - $52,000 annually) and when you add in 20-25% benefits and contributions the total maximum cost in America for a Medical Biller could be up to $65,000 per year or $31.25 per hour.
Medical Coders make $52,414 per year or $25.19 per hour, and now add in the 25% benefits and contributions and you're paying $31.50 per hour or $52,000-$54,000 per year. If you have a Medical Coder that also does your Medical Billing, you will surely be paying that person $45-$50 per hour plus benefits. So the costs for medical are average across skilled trades but these two positions are not an option, they are required for you to get paid at all, let alone faster.
Owners and Managers Need to Review Medical Billing
It's Your Duty to Understand the Speed and Accuracy of their Billing for your Claims
Internal or Outsourced Billing Companies and Coders should have no more than 5% errors. If your'e billing $100,000 a month, that means you're okay with $5,000 in delayed or lost billing. Us personally, we'd find a way to get that to 1% or less. In fact PCG Software's IVECoder can help you do that, just ask us for more info by clicking here: Reduce billing denials
To ensure the financial success of your practice, clinics must review the accuracy of their medical billers and coders. It’s important to review billing trends regularly, as this should lead to reduced denials and faster reimbursements. Tracking what is billed to insurance carriers helps identify any errors or areas for improvement in the clinic's revenue cycle processes. If a discrepancy exists between what is billed and what was actually provided to the patient, it should be swiftly corrected to avoid potential losses. A review with an experienced team of professionals can also help identify coding changes or payer requirements that may have been overlooked by the staff.
AI Billing Softwares to Help Novice and Experienced Coders and Billers
With the introduction of PCG Software and its AI coding tool, iVECoder, medical billers have been provided increased support when making sure medical bills are accurate. The mock adjudications included in iVECoder give a layer of protection against errors, ensuring the biller has correctly inputted all necessary codes to avoid any issues in the billing process. The PCG software is flexible and user-friendly, it provides an intuitive platform to simplify the communications between insurance companies and medical professionals while also providing support to help ensure maximum accuracy. This leads to reliable processing that reduces potential financial losses due to inaccurate coding.
Summary:
Trying to find both a medical coder and medical biller in one person is costly and rare. You'll likely need one of each or multiple dependent upo the size of your practice(s). If you're hiring an outsourced billing solution, if they don't have medical coding as an option, keep looking for a vendor. The two roles are different but inter-related and one with the other will leave you 8-15% reduction in cashflow every month. Good luck out there and if you need a software to help reduce denials, click the Provider Resources button below or call or email us today.
