Medical Billing & Coding Explained

Medical Billing and Transcriptionist

Getting Started in Medical Billing & Coding

Medical billers & coders are typically known as the “office staff” in a medical capacity. Although this term hardly does justice to all the work billers & coders do, it arises from the fact they they almost always work with the administrative side of health care.

Rarely, if ever, come into contact with patients outside of the waiting room. In fact, some medical billers work in entirely different offices or buildings from the one in which patients are cared for.

Medical Billing vs. Medical Coding

Although medical billing & coding is often a single term, there are actually two sides to the job: billing and coding.

A medical coder is primarily responsible for filling out paperwork according to a national standard. This involves taking a patient’s charts and converting everything contained in it to a series of alphanumeric codes (known as ICD-9-CM) that are then used to determine how much to pay the physician for his or her work. A medical biller focuses more on the accounting side of things, making sure that patients and their insurance companies are billed the correct amount.

In both fields, the use of modern, updated billing software is key. Although there are national standards requiring that offices, hospitals, and insurance companies follow the same protocol, this protocol is being constantly updated and improved. This means that billers & coders have to stay abreast of the current technologies.

Educational Options for Billers & Coders

Because incorrect billing procedures can result in lawsuits, most employers prefer to hire professionals with some level of vocational training. Training is typically offered through private vocational institutions in the form of nine-month to two-year programs, although most community colleges also have similar options.

When selecting a school for medical billing & coding, it’s important to ensure that the education being provided is current with the industry standards. Most community colleges offer adequate training in the field; in most cases, they provide general education credits and medical billing and coding classes to award Associate Degrees.

These schools also typically provide access to the certifications recommended to ensure a good job prospect. Most students turn to private vocational institutions for medical billing & coding training.

On the positive side, courses can often be completed in as little as nine months. On the negative side, students are often misled in terms of the outcome of their training.

Before choosing a school, it is best to make sure that graduates are able to sit for the necessary certification exams, that the diploma or degree is recognized by employers, and that the cost of the education is proportionate to the average starting income.

Because of the nature of the work, online courses are becoming increasingly popular for this particular field. Students should always check the accreditation of their prospective schools and ensure that the course outcome aligns with their professional goals.

Although medical billers & coders typically stay away from the clinical side of patient care, they must still have a sound understanding of medical terms, anatomy and physiology, and other health-related issues, so its best to ensure that course topics include these essentials.

Benefits of Medical Billing & Coding

Job prospects for qualified billers & coders is incredibly high in the United States, with jobs only expected to increase in number in the next 10 years. Because of the nature of health care and insurance, there are literally thousands of different types of medical services and health insurance plans to cover them.

Navigating through these many managed care plans is increasingly complex, and most doctors’ offices and insurance companies require a staff on board to get the paperwork filed correctly.

Jobs are typically found in physician offices, but hospitals, pharmacists, resident care facilities, insurance companies, consulting firms, and even lawyers sometimes have medical billers & coders on staff. This diversity of employment options means that good billers & coders can command higher prices and great working conditions.

In entry-level jobs, medical billers & coders typically make about $13 per hour. These wages increase substantially with more experience and specialization, often reaching up to $30 or $40 per hour.
One of the unusual benefits of being a medical biller & coder is the possibility of working from home.

Although this option isn’t available to everyone, many work as either “freelance billers” for a number of clients or for large firms that allow telecommuting.

Medical Billing & Coding Certification Options

There are a number of different certifications available to those in the field. The American Health Information Management Association offers three certifications: Certified Coding Associate (CCA), Certified Coding Specialist (CCS), and Certified Coding Specialist, Physician-Based (CCS-P).

Of these, the CCA is typically held by beginners in the field, while those with more experience and education strive for the CCS (typically for work in hospitals) and CCS-P (typically for work in physicians’ offices).

The American Academy of Professional Coders offers similar options, including the Certified Procedural Coder (CPC), the Certified Procedural Coder, Hospital (CPC-H), and Certified Procedural Coder, Payer (CPC-P).

The last of these, the CPC-P is used primarily for work in insurance companies and government health care payout organizations.


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