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Key Takeaways
- Medical billing and coding are related healthcare industry occupations that ensure reimbursem*nt and accurate medical record keeping.
- The medical coding process involves using code sets to translate medical providers’ notes into standardized codes that healthcare organizations use to maintain patient medical records and generate billing claims.
- Medical billers use these codes to create billable claims, then submit these claims to payers and track each claim to ensure payment.
- Medical records specialists such as medical billers and coders need thorough understanding of standardized codes and industry software, along with strong communication skills.
- These professionals work throughout the healthcare sector, including in hospitals, doctors’ offices and other medical facilities. They can also find jobs at insurance companies, government agencies and law firms.
Not all healthcare professions require a degree from a medical school. You can break into the healthcare industry by becoming a medical biller or coder—and you don’t have to earn a degree to do so.
What is medical billing and coding? The two professions are related, but they’re not the same.
In simple terms, medical billing is the process of ensuring healthcare providers receive payment for the services they perform. Medical coding, on the other hand, is the process of translating health and patient information into a universal code.
If you have a detail-oriented, analytical outlook and want a healthcare career you can start quickly, medical coding and billing might be a great fit for you. Discover what this field is all about with our guide.
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What Is Medical Billing and Coding?
Medical billing and coding keep revenue flowing through the U.S. healthcare system. At the highest level, medical billing and coding professionals streamline the reimbursem*nt cycle to ensure providers are paid for their services and that patients are billed correctly.
Medical billers and coders keep patient records, calculate charges and review files. They handle insurance claims accurately and efficiently.
Medical coders use specialized coding classification systems to translate a healthcare provider’s diagnosis, procedure, prescription or other services into standardized codes. Common classification systems include Current Procedural Terminology®, International Classification of Diseases (ICD-10-CM) and Healthcare Common Procedure Coding System (HCPCS) Level II.
Medical billers then use these codes to create billable claims that can be submitted to payers (such as insurance companies) or clearinghouses. They also monitor these claims to ensure that the provider receives payment.
Medical Billing vs. Medical Coding
While certain aspects of medical billing and coding overlap, they’re not identical tasks. For example, medical billing is often patient-facing, whereas medical coding occurs behind the scenes.
What Is Medical Billing?
Billing involves creating bills, also known as claims, to send to health insurance companies or patients. If a patient has health insurance, a medical biller sends claims to the insurance company. In this case, the insurance company will compensate the healthcare provider. If a patient does not have health insurance, medical billers send bills directly to the patient for compensation.
Medical billers and coders may work together to create what’s known as a superbill, or an itemized form to create claims.
After an insurance company receives a claim, it will determine how much it will pay through a process called adjudication. In cases where a company will not pay the entire claim, it is a medical biller’s responsibility to revise and resubmit the claim or to bill the patient for the remainder. Billers must keep track of all claims to ensure payment from the responsible parties.
What Is Medical Coding?
When a patient arrives at a hospital or other healthcare facility, medical professionals record the services, medications and procedures provided and the reason for each service. These details are known as clinical documentation.
Medical coding involves analyzing clinical documentation and linking each service, medication and procedure with its designated code. Those codes, recognized within a standardized coding system, synthesize what providers did during a patient visit.
In addition to providing the information medical billers use to generate billable claims, the medical coding process is essential to accurate medical recordkeeping at the population level. The use of codes facilitates data tracking and statistical analysis in the healthcare field.
What Are Medical Biller and Coding Jobs?
What does a medical biller and coder do? In many cases, one person can tackle both medical coding and billing, but the tasks are sometimes split between billing and coding specialists.
In the coding process, medical coders review physician notes, patient records, lab results and other clinical documentation. Medical coders assign standard medical codes to each service or diagnosis. These professionals then pass the codes to the medical biller who uses the codes to create claims.
Many medical billers and coders work for hospitals, physician’s offices, health insurance companies, law firms and public or governmental agencies. Some medical billers and coders work remotely, either as independent contractors or with a company. Most work full time.
The U.S. Bureau of Labor Statistics (BLS) projects an above-average 8% growth for medical records specialists—a category that includes medical billing and coding jobs—between 2022 and 2032. The BLS expects an average of 15,000 annual job openings for medical billers and coders over the decade.
With a median annual wage of $48,780 in this profession—equating to roughly $23.45 per hour—medical billing and coding salaries are typically on par with the national median of $48,060 per year.
Skills Used in Medical Billing and Coding
Medical billing and coding is a technical and analytical job. It also requires the ability to communicate well. You’ll need to feel comfortable using coding software and standard coding systems. Having excellent customer service skills will come in handy, too.
Professionals in this field usually need medical billing and coding certification. To fulfill the requirements for medical billing and coding certification, you should complete a reputable training course to learn the skills needed to succeed in this role.
Communication Skills
Depending on their specific roles, billing and coding professionals regularly interact with other billers and coders, healthcare professionals, patients and insurance companies. In a single day, medical billers and coders—particularly those who perform both functions—might need to decipher medical jargon, clarify a dispute with an insurance company and answer a patient’s billing questions.
Billers and coders must learn to navigate interpersonal communications with efficiency and clarity.
Ability to Work with Billing and Coding Software
Coding software is a fundamental component of medical billing and coding. Some software programs you might use on the job include CodeLink® Online and 3M. You’ll need to feel confident with each.
Medical billing software might include programs like DrChrono, AdvancedMD and CureMD.
Customer Service Experience
Many medical billers interact with patients frequently, so handling requests and inquiries with expert customer service is essential. The world of medical billing is complex, and patients may not understand technical terms or medical jargon. As a medical records professional, it’s up to you to bridge the gap.
Knowledge of Medical Coding Systems
A top-notch understanding of standardized code sets used to file claims is the backbone of the medical coding and billing fields. These codes classify key services completed during a patient visit such as procedures, drugs administered, supplies and equipment used, and nonphysician services.
Frequently Asked Questions (FAQs) About Medical Billing and Coding
Is medical billing and coding hard?
Medical billing and coding is a technical profession that demands excellent communication and attention to detail. For some individuals, these factors can make the profession challenging, but for those who possess those qualities, being a medical coder or biller can provide a stimulating and satisfying career.
Does medical billing and coding require math?
Pursuing a medical billing and coding career does not require a knowledge of advanced mathematics, but professionals in this field do need basic math skills. Medical coders and billers may be called upon to calculate charges related to medical bills and convert units of measurement, and they may sometimes engage in statistical analysis.
How long does it take to learn medical coding and billing?
To learn medical coding and billing, you should enroll in a course from a reputable provider. A good medical billing and coding course usually takes six months to a year to complete and prepares you to pursue certification in the field. To expand your career options, you can also pursue a two-year associate or four-year bachelor’s degree.
Is medical coding a stressful job?
Medical coding can be a stressful job for some professionals, but it depends on your workplace, skills and outlook. Medical coders must interact with patients, providers and colleagues; fulfill productivity goals within set deadlines; and meet high standards for accuracy, which some coders may find stressful.
Are medical billing and coding separate jobs?
Medical coding and billing are related professions, but each one requires a distinct set of skills and responsibilities. Medical coders convert patient information into standardized numerical and alphanumeric codes, while medical billers use this encoded information to create billable claims. At smaller medical practices, however, one worker may tackle both roles.
Which credential is best for a medical coder?
The best-known certifications for medical coders come from the American Health Information Management Association (AHIMA), AAPC, the National Healthcareer Association and Practice Management Institute. AHIMA and AAPC each offer multiple credentials for medical coders with varying experience levels and professional specializations.
Does having more than one credential help you as a medical coder?
Having multiple credentials can definitely help you as a medical coder. In addition to expanding your job options, holding more than one certification can improve your earning potential. According to a 2024 salary report from AAPC, a leading credentialing organization for the medical billing and coding field, medical coders with two or more certifications outearn those with only one certification by $10,000 or more per year on average.
Can you specialize as a medical coder?
Yes—in the medical coding field, specializations are often related to workplace type, and you can earn credentials to demonstrate your specialized knowledge. For example, AHIMA’s Certified Coding Specialist – Physician-Based® caters to coders working in doctors’ offices, while AAPC’s Certified Outpatient Coder® makes sense for those employed in emergency departments, outpatient clinics, and ambulatory surgery clinics. Coders with the Certified Inpatient Coder® credential from AAPC often work in general hospitals, skilled nursing facilities and inpatient rehab facilities.
