Many practices are stymied by the difference between a “biller” and a “coder”.  Why would a practice need both?  Are there any other alternatives?

Well, there is a major difference and it is possible to find one person who can do both…if you are lucky!

A “Coder” is trained in CPT and Medicare coding guidelines.  They should understand Documentation Guidelines in determining coding for Evaluation and Management services.  In addition, they are trained in coding HCPCS and ICD-9, as well.  The coder is usually more “black and white”, they look at coding as somewhat of an exact science.  The problem that I see is when you put five coders in the same room and ask them to code the same thing, you will probably have five different answers!

The “Biller” will be more the “gray-area” thinker.  They see how claims are paid by each health plan.  They know that each health plan has their own reimbursement policies and that the “rules” are consistently inconsistent.  They may not be as well versed in the exact coding of services, but they know how each health plan reimburses specific codes and coding combinations.  If I have a question regarding how a specific health plan reimburses an office visit on the same day as a preventive medicine visit, I will ask my Biller.

Typically, you will find that an employee has either a “coder” or “biller” perspective.  Each are good and needed by physicians; however, there are some people out there who have both perspectives and they are Golden!  If a practice is fortunate enough to bring on an employee with both viewpoints, they will have a valuable asset on staff.