Medical Billers: The First And Last Players In The Billing Game

by  Find-A-Code™
Jan 25th, 2023

When it comes to medical coding and billing, there are a lot of players in the game. From reception staff to clinical staff and the back office, there are quite a few people involved in generating billable services and then actually billing payers for them. The medical biller is the first and last player in that game.

For the record, medical coding and billing are two separate disciplines. There is a point at which they intersect, but coders and billers are different team members with different functions.

Medical coding does not begin until after a patient's visit or procedure is complete. Medical billing begins as soon as the patient arrives and registers. Medical billing is not complete until an invoice has been scrubbed and sent to an insurance company or Medicare/Medicaid.

Medical Billing and Coding Basics

Both medical billing and coding involve tens of thousands of medical billing codes covering everything from procedures to medical conditions. Coders and billing specialists alike need to understand how the coding system works.

A medical coder's responsibility is to extract billable data from a clinician's notes and translate that data into standard codes. For example, imagine a GP seeing a patient who believes he has COVID. Not only will the GP consult with the patient, but she might also order certain tests. Everything involved in that visit needs to be translated into billing codes.

Once the medical coder finishes up, the medical biller takes over. It is the biller's responsibility to utilize the codes to create an invoice. Every invoice is scrubbed for accuracy before being submitted for payment.

Two Types of Medical Billing

Medical billing is divided into two distinct types: front end and back office. Front end billing begins as soon as the patient arrives at the provider's facility. Front end functions can be performed by the reception staff or a billing specialist who works alongside reception.

The initial duties involve beginning a paper or electronic form that contains basic information about the provider and patient. It includes the date as well. If the purpose of the visit is already known, an initial code is entered to get the ball rolling.

Back-office billing kicks in once the medical coder finishes her work. It is not uncommon for billers and coders to work together to decipher some sort of billable data not made clear by the person who rendered services.

The Biller Must Be Satisfied

The medical biller is considered the last player in the game because she has to be satisfied with the accuracy of a particular invoice before it can be submitted. That's where scrubbing comes in. Scrubbing is the process of going through a billing form to make sure everything is accurate.

Understand that accuracy is not limited only to medical billing codes. Patient and provider information must also be accurate. Only when the biller is satisfied with accuracy is an invoice ready for submission. Then it is on to the payer and eventual reimbursement.

From Days to Months

Because medical building codes are so complex, billing is by no means a quick process. Simple visits and procedures requiring minimal diagnostic code lookup could be completed in a day or two. But the most complex bills can take months to prepare. It really depends on how much is involved in treating the patient.

Medical billers are important players in making sure that healthcare providers are paid for their services. Billers are the first and last players in the game, responsible for initiating the bill and then completing invoices prior to submission. The quality of their work directly affects payments.