Medical billing and coding may seem like similar jobs to the average physician since they both lead to payment of claims. However, they are two very different roles, and each has its own area of expertise. Sometimes these tasks are performed by one person who has studied in both areas, but this is less common.
Both coders and billers can become certified through nondiploma programs, and certification must be maintained through continuing education. The American Academy of Professional Coders (AAPC) reported that the average salary of a certified medical coder was $49,872 in 2016. This figure varies by experience, education level and geographic location.
What Medical Coders Do
Medical coding is the first step toward getting the practice reimbursed for services rendered. A coder's job is to apply ICD-10-CM and CPT codes to any patient billables. The CPT codes describe what procedures are being billed, and the ICD-10-CM codes apply a diagnosis to explain why the procedures have been conducted. For instance, a CPT code would be assigned for a diagnostic ultrasound of the uterus, and an ICD code would be assigned for a diagnosis or suspected diagnosis of a mass or other abnormality.
Coders also have training in medical terminology and anatomy. Part of their job includes reading through doctors' notes and patient charts to discern what codes should be applied. A proficient coder is knowledgeable enough to question inconsistencies in a chart's documentation to avoid assigning codes that do not properly match diagnoses to billable services.
What Medical Billers Do
Medical billers are the second and final link between a medical practice and reimbursement. A biller's job is to take what the coder has done and apply reimbursement rules to it. This person bills both third-party payers and patients. He or she also determines the allowable charges, as well as what is and is not covered by insurance, to build an appropriate claim. Finally, the biller ensures that claims are factual, correct and submitted in a timely manner.
After claims are submitted, it is the biller's job to follow up with insurers if a claim is rejected or not paid quickly. A skillful biller will know when to send a claim to collections or when it is time to write off bad debt. The biller's responsibilities also include talking with patients about bills and helping them understand what is covered by their insurance.
To Hire or to Outsource Medical Billing and Coding? That Is the Question
If a gynecology practice is considering whether to hire staff for medical billing and coding, knowing its volume is important. Outsourced coders are generally paid a fee per chart. Medical billers can be paid in several ways: by a fee per claim filed, a percentage of what is billed or a percentage of what is collected.
While small practices might be able to find one special individual to perform both duties, larger businesses might need two employees for these important jobs. If two employees cost approximately $100,000, based on salary averages, it might be worth conducting a cost analysis to determine how much outsourcing these services saves per year.
A business that hires rather than outsources its medical billing and coding needs to look for the right person with the experience and knowledge to maximize receivables. Look for certifications that are verifiable and tailor interviews to learn what specific skills each applicant has. A formal certification ensures that the biller or coder is required to complete continuing education, which is necessary to keep up with coding requirements that often change each year.
Good medical billing and coding are the lifeblood of a gynecology practice. It's critical to hire the right people who can keep revenue pumping through your practice at a steady rate.
