What Is Medical Billing And Coding?

Meta Description: Do you want to know what medical billing and coding is all about? This comprehensive guide will tell you everything you need to know!

Medical billing and coding is the process of submitting and tracking medical claims with insurance companies. It can be a complex process, but it’s important to make sure that all of your bills are submitted correctly, so that you get reimbursed for the services you provide.

Let’s take a closer look at what medical billing and coding entails.

RELATED: More Electronic Options for Patients and Providers

Medical Billing and Coding: An Overview of the Basics

What Is the Difference between Medical Billing and Medical Coding?

Medical billing and medical coding are two terms that are often used interchangeably, but they actually refer to two different aspects of the healthcare industry.

Medical billing is the process of submitting insurance claims to insurance companies and other payers for reimbursement.

Medical coding, on the other hand, is the process of assigning codes to diagnoses and procedures. These codes are used for reimbursement and record-keeping purposes.

Medical billing and coding are complex and ever-changing fields, but they are an essential part of the healthcare system. Providers rely on accurate coding in order to get paid for their services, and patients benefit from having their insurance claim processed quickly and efficiently.

Additionally, it’s important to note that medical billing and coding are not the same as medical transcription.

Transcriptionists listen to audio recordings of patient encounters and transcribe them into written reports. Billers and coders, on the other hand, work with patient records to ensure that the correct codes are being used and that claims are being filed correctly.

What Is Medical Billing?

Medical billing is the process of submitting and following up on claims with health insurance companies in order to receive payment for services rendered by a healthcare provider. The process can be completed by the provider’s office or it can be outsourced.

Front End Medical Billing

Front end medical billing refers to the process of verifying patient’s financial responsibility and patient’s health plan, and ensuring that all necessary documentation is in order. This involves contacting the insurance company for insurance eligibility verification.

Front end medical billing is important because it helps to avoid any surprises or delays during the actual appointment or procedure.

For example, if a patient’s insurance does not cover a certain medical service, the front-end medical biller can let the patient know ahead of time so that they can make other arrangements.

Back End Medical Billing

Once a provider has rendered care to a patient, the back-end medical billing process begins.

This is the process of submitting insurance claims and following up on unpaid claims. It involves completing and submitting claim forms, as well as contacting insurance companies to check on the status of claims.

This process can be complex, but it’s important to make sure that all claims are submitted correctly in order to avoid any delays in payment.

It’s also important to follow up on any unpaid claim or accounts receivable so that you can get reimbursed for the healthcare services you provide.

The back-end medical billing process can be time-consuming, but it’s essential for getting paid for your services.

What Is Medical Coding?

Medical coding is the transformation of healthcare diagnosis, procedures, medical services, and equipment from the medical records and clinical documentation into standardized codes. These code sets enable consistent recording and data sharing across all healthcare settings.

Medical coding also ensures continuity of care and patient safety by providing the necessary detail for accurate reimbursements from insurers, billing companies, and other health organizations. In short, medical coding is essential to the efficient and effective running of the modern healthcare system.

The process begins with the health care provider completing a medical claim form. A medical coder assigns diagnosis and procedure codes to patient records, which are then used by insurers to determine how much to reimburse providers. They are also used by healthcare facilities and government programs to track statistics and measure quality of care.

Like medical billing, medical coding is a complex process. A medical coder must have a thorough understanding of the coding process and be able to correctly assign codes to diagnoses and procedures.

There are three main medical coding classification systems:


The International Classification of Diseases (ICD) is a system used by healthcare professionals to classify and code diseases. The most recent version, ICD-10, was released in June 2018.

ICD-10 contains significant changes from the previous versions, including an expansion of the mental health section and the addition of new codes for conditions such as post-traumatic stress disorder (PTSD).


The Current Procedural Terminology (CPT) code set is a medical code set that is used to report medical procedures and services to insurers.

The American Medical Association develops and maintains the CPT code set, which is updated on an annual basis.

The CPT code set is divided into four categories:

Category I

Category I CPT codes are five-digit numeric codes that identify medical services and procedures. The codes are numbers that range from 00100 to 99499. They are intended to improve communication between physicians and other health care providers, as well as provide more detailed information for reimbursement and research purposes.

Category I codes are generally divided into subcategories based on the type of procedure or service being performed, as well as the anatomy involved.

The accurate reporting of Category I code is essential in order to ensure that patients receive the correct level of care and reimbursement.

Category II

Category II codes are supplemental codes that can be used for performance measurement. These codes are not required for billing purposes, but they can provide additional information about the services rendered.

For example, a physician may use a Category II code to document the type of patient encounter, the level of difficulty, or the presence of complications.

In some cases, the use of these codes can help to improve the quality of care by providing more detailed information about the services rendered.

Additionally, these codes can be used to track outcomes and compare results across different providers. As a result, they can play an important role in quality improvement initiatives.

Category III

Category III codes are temporary alphanumeric codes used to identify new and developing technology, procedures, and services. These codes allow for better tracking and data collection during the early stages of the relationship between patient and medical provider, when there is typically less information available.

Proprietary Laboratory Analyses (PLA) Codes

PLA codes are used by laboratories to identify the tests that they perform.

Health Care Common Procedure Coding System (HCPCS) Level II

HCPCS Level II is a classification system used by healthcare providers to report services and supplies. The system includes codes for everything from medical procedures to durable medical equipment.

How Do Medical Billing and Coding Professionals Help the Healthcare Industry Run More Efficiently?

Medical billers and medical coders play a vital role in the healthcare industry. They are responsible for ensuring that patient records are accurately coded and billed, and that providers get paid for their services.

Medical billers and medical coders also help to track statistics and measure quality of care. By correctly coding patient records, they can help identify patterns of care and potential areas for improvement.

RELATED: Medical Billing Authority’s Thoughts on those KPIs that should be Followed for Practice Financial Health

How Do You Become a Medical Biller or Medical Coder?

There are a few different ways to pursue a medical billing and coding profession:

Certificate Program

Many community colleges offer certificate programs in medical billing and coding. These programs typically take one year or less to complete and often include an externship component.

Most certificate programs can also be completed entirely online, making them a convenient option for busy adults. Online medical billing and coding programs allow students to complete coursework at their own pace, making it easier to balance school with work and other responsibilities.

There are a number of different certifications that medical billing and coding specialists can pursue, such as the Certified Professional Biller (CPB) and Certified Professional Coder (CPC) certifications.

Associate Degree

Some colleges offer two-year associate degree programs in medical billing and coding. These programs provide more comprehensive billing and coding training than certificate programs, and they often lead to higher-paying positions.

Bachelor’s Degree

A few colleges offer four-year bachelor’s degrees in health information management, which include coursework in medical billing and coding. These degrees are not required for most entry-level positions, but they may lead to higher-paying jobs.

What Is the Job Outlook for Medical Billing and Coding?

The job outlook for medical billing and coding is positive. The Bureau of Labor Statistics projects that employment in this field will grow 9% from 2020 to 2030.

This growth is largely due to the increasing use of electronic health records and the implementation of new coding systems. As such, there will be a need for skilled professionals who can accurately code diagnoses and procedures.

What Are the Benefits of Medical Billing Services?

Free Up Your Time

Medical billing services can save the medical provider time as well as expense. Billing is complex and time-consuming. By outsourcing this process to a medical billing service provider, you can free up your time to focus on other aspects of your practice.

Increase Your Revenue

A good medical billing service will have a detailed understanding of the insurance reimbursement process and will work to get you the maximum reimbursement for your services.

Additionally, medical billing services can help improve your cash flow. A good biller will work to ensure that claims are processed quickly and accurately, which will help reduce the amount of time between when services are rendered and when you receive payment.

Take Better Care of Patients

Medical billing services can help you improve your patient care. A good biller will work with you to ensure that all of the necessary documentation is submitted to insurance companies, which will help to ensure that patients get the care they need in a timely manner.

What Are the Benefits of Medical Coding Services?

Improve Your Accuracy

Medical coding services can help to improve the accuracy of your claims. By correctly coding diagnoses and procedures, you can ensure that your claims are processed accurately and quickly.

Improve Your Reimbursement Rates

By correctly coding diagnoses and procedures, you can ensure that you are reimbursed at the correct rate.

Improve Patient Care

Medical coding services can help to track statistics and measure quality of care. By correctly coding patient records, you can identify patterns of care and potential areas for improvement.

Cut Administrative Expenses

Both medical billing and coding services can help reduce your administrative costs. By outsourcing these processes, you can reduce the need for in-house staff, which can save you money on salaries and benefits as well as supplies, clearinghouse costs, etc.

The Bottom Line

As you can see, medical billing and medical coding are important aspects of the healthcare industry. They are complex processes that involve a lot of detailed work.

However, they are also a critical part of ensuring that you are able to get reimbursed for the services you provide.

If you are looking for medical billing and coding services that can take the hassle out of your work, contact us. Our team of experts can take care of all your healthcare revenue cycle management services so you can focus on what you do best–providing quality healthcare to your patients.

Up Next: