When you receive a bill from a hospital, your medical insurance, or other healthcare provider, it is full of codes outlining the specific procedures and healthcare services performed. Medical coding involves translating medical reports and health information into codes used by healthcare professionals and medical insurance companies. Medical billing involves submission of these reports into claims sent to medical insurance companies. Both medical billing and coding specialists must know how to interpret medical records and learn the various codes. Because medical billing and coding standards change and become more complicated over time, anyone working as a medical billing and coding specialist, a certified coding associate (CCA), or health information technician must undergo regular continuing education and medical billing and coding training.
A medical billing and coding specialist or health information technician may work in an office setting, although many work remotely with various healthcare services to perform diagnostic coding and track patient's health information and never have to leave their homes to do their jobs. While most billers and coders perform different jobs, smaller medical offices and facilities may want one person to combine these tasks. Medical billing and coding professionals work in all sorts of healthcare environments, but may also work at medical insurance companies, government agencies, and health information technology or data management firms. Virtually all work is done by computer, so a person must feel comfortable sitting during their work time.
The U.S. Department of Labor’s Bureau of Labor Statistics (BLS) expects the job outlook for medical records and health information technicians to rise by 13% over the next decade, faster than the national average. The healthcare industry is the largest in the nation, and an aging population fuels the need for more workers in the field of medical billing and coding. Prospective students have options when they look for medical billing and coding programs within a community college, technical college, or even a university. They may complete and associate degree program or a medical billing and coding certificate program, among other options. Programs that lead to coding certification will encompass a variety of billing and coding classes. These may include courses in anatomy, health information technology, medical insurance programs, medical terminology, diagnostic coding, and more. Prospective students and learners can also find an online medical billing and coding program. Completing a program in medical billing and coding online or on campus will prepare students for entry-level positions throughout the U.S.
Components of A Successful Medical Billing & Coding Career
Perhaps one of the best ways to gauge the success of a medical billing and coding career is by how many bills are returned due to coding and/or billing errors. If the rate is very low, the person doing the job is good at their task. This is a job requiring attention to detail and good organizational skills. The information contained in billing and coding goes beyond a patient and insurer. Because the codes are standardized, the CDC can analyze the scope of current prevalent diseases in an area via code analysis. A successful medical biller or coder understands the importance of their work and accepts that continuing education is necessary to keep current on updates to the coding system. In just the last few years there was a major update to coding that required all new training for many in this profession.
While medical billing and coding are used as a job description, they are closely related but not identical procedures. Coding involves translating some form of medical information, such as a prescription or diagnosis, into a code for billing purposes. There are literally thousands of such codes, used for every type of illness, injury, and procedure. When a patient enters the doctor’s office, a nurse may perform initial tests, and then the doctor examines the patient, makes a diagnosis, and offers treatment options. Every one of those actions corresponds to a code. The information recorded at the patient’s visit is given to medical coder, who “translates” the office visit into a list of codes for billing purposes. International Classification of Diseases (ICD) codes are used for the patient’s specific illness or injury, while the Current Procedure Technology (CPT) codes correspond to the services and treatment the patient received. Such code sets all have their own regulations and guidelines, and many require a particular order placement on an invoice.
The coder has the responsibility of entering the code data into a software program. It then goes to the biller, who uses that information to prepare the claim for the insurance company. The insurance company evaluates the claim and returns it to the medical biller. The medical biller then ascertains how much the patient owes based on the individual’s health insurance policy, and sends the invoice to the patient. If the patient does not pay the bill after a certain period of time, the medical biller must send the unpaid invoice to a collection agency.
Typical Medical Billing & Coding Trade School Requirements
You will usually need either a high school diploma or GED to begin training as medical biller or coder at a technical school or college. There are online certification programs that promise certification without the pre-requisite of a high school diploma or GED but be careful to check into these programs very closely before paying for their courses. Call employers in your area and ask if they would hire someone who obtained a certification from one of these programs. The answers will likely vary by region and you want to make sure that, whatever certification you receive, it will allow you to begin work right away in your new profession.
Typical Medical Billing & Coding Certifications Needed
A medical biller should receive certification as a Certified Professional Biller, or CPB. Certification shows the individual possesses the skills necessary to submit claims as per private insurer and government regulations, resolve claim denials, regularly follow-up claims, and post payments and adjustments. They will also know how to appeal submissions and send claims for collection. A medical coder should receive certification as a Certified Professional Coder (CPC). Certified coders are well-versed in medical code sets, surgical coding, coding guidelines and compliance practices.
Exam or Experience Needed for a Medical Billing & Coding Certification
Medical billing graduates should take the National Healthcare Association’s Certified Professional Billing (CPB) exam. Coding graduates should take the American Association of Professional Coders (AAPC) credentialing examination once they have received their certificates. The AAPC offers various certifications, such as specialty coder, inpatient coder, outpatient coder, and risk adjustment professional.
Professional Organizations
AAPC
American Academy of Professional Coders
The AAPC is the largest credentialing and training program for medical billing and coding workers. Membership includes four free webinars annually, as well as discounts on professional development and continuing education courses. The organization also offers extensive networking opportunities for those seeking new jobs, mentoring, or just the desire to boost their professional support system.
HBMA
Healthcare Billing and Management Association
The non-profit HBMA is a member-led organization, representing more than 40,000 employees of professional billing departments and revenue cycle management companies. Its message boards are among the useful for any professional medical biller and coder, where they are able to ask general and specific questions about their field. HBMA offers certification for healthcare billing employees, as well as opportunities for professional development and continuing education.
MAB
Medical Association of Billers
MAB offers the nationally recognized credential of Certified Medical Billing Specialist, the oldest type of medical billing certification in the country. MAB also offers the Certified Medical Records Technician certification. MAB is an approved federal agency vendor, and its curriculum is licensed by the Commission for Post-Secondary Education.