The Importance of Medical Billers and Coders in the Healthcare Industry

Medical Billers and Coders play an integral role in the medical industry. They perform most of the behind-the-scene tasks whilst providing a smooth and comfortable experience for the patients. This job’s demand is really high which is expected to increase by 13% by 2026.

The role of medical coders and billers is very crucial, however, very few people know about their contribution to the healthcare industry. Mostly healthcare providers hire different individuals to perform coding and billing tasks but there are also offices where a single individual performs the duties of both: a medical biller and a coder.

To understand the importance of medical billers and coders, we need to first learn what their day-to-day duties are.

The main role of a medical coder is to provide decoding services, interpreting patient’s documentation and making suggestions about the appropriate procedures. Most of their time is spent in properly analyzing the medical data, decoding medical documents, and checking for any errors.

On the other hand, the duties of medical billers start once the coders have decoded the medical data. Medical billers then prepare claims and submit to insurance companies, using suitable codes.

They also follow up with insurance agencies to make sure the claim has been timely approved. If in case, there are any errors, they talk to the patient and keep them updated with the current status of their claim.

Other than that, they also review and prepare statements for patients to make sure they are error-free. The coders and billers should be well-equipped with certain software to organize and maintain data.

Helping to Improve Patient-centric Care

Both the medical billers and coders make sure that they deal with insurance payments of the patients so the doctors can perform their duties without having to worry about other medical billing tasks. They are the key to successful revenue cycle management (RCM) in the healthcare business.

Medical coders are quick at determining the medical procedure for patients by using alphanumeric codes. They convey the most efficient and fast medical treatment to the patients. They are also helpful in translating difficult medical terminologies into simpler words to create an understanding among the medical insurance providers and the healthcare providers in the medical business.

Medical coders and billers take medical information from various sources like transcriptions, laboratory results, and electronic data to translate the treatments into codes.

medical billers

Medical coders record these codes into the medical system to be used by medical billers who then file insurance claims for patients and insurers. They must also ensure the confidentiality of both the patient and the insurer. Without coders, the billing process cannot even start.

The medical environment is rapidly changing and the need for coders has increased even more as physicians are required to keep a proper check on different undiagnosed medical services and treatments to ensure timely and proper payment.

Compliance with Contractual Rules and Regulations

Another job of medical coders and billers is to comply with the medical rules and regulations. They must follow the guidelines issued by the Health Insurance Portability and Accountability Act (HIPAA) and other such agencies.

They have to keep in mind the confidentiality and other rules related to medical practices. They also need to properly understand the rules before signing a contract with an insurance company and follow those rules in the future. A good medical coder or biller ensures that all the contractual rules are being followers while practicing medical procedures.

Medical coders also ensure that the data they are using is safe and secure and is not being handed to anyone that might breach the confidentiality of the contract. That is why the healthcare industry hires coding specialists who understand the security measures and follow the rules.

Smooth Flow of Payment

Medical billers are also responsible for the smooth flow of medical payments in healthcare. They must create an understanding of all the private and government medical billing rules and regulations before filing a claim. They need to efficiently manage claims by having vast knowledge about how to handle claims denial, claim follow-ups, submission of appeals, billing of claims, and other such matters.

Several healthcare institutes provide training workshops to its students so that they are better equipped with the knowledge of medical inpatient and outpatient care services.

Now we know that medical coders and billers are truly an integral part of the healthcare system. Physicians are the ones who do most of the visible job but without specialized coders and billers, they cannot properly perform their jobs.