What is Medical Billing & Coding

What Is Medical Billing and Coding?

And Other Frequently Asked Questions

There are many TV and print ads about the medical billing career field. Some of these ads are from accredited career schools that can provide students with the right training and education, but other ads try to tease people into buying a self-study course.

Sadly, the medical billing industry is rife with scams and diploma mills, so it's vital to research any medical billing school you plan to attend. There are some articles on this site that discuss ways to find good medical billing schools.

This page answers frequently asked questions (FAQs) that students may have about medical billing and coding:

What is medical billing and coding?

When a patient has any medical exam or procedure, the medical office will work with the patient and the patient's insurance company for claims. The biller will submit and follow up on any claims in order to receive payment for services rendered by the health care provider. This usually involves learning many codes, each one representing a symptom, medications and diagnoses, in order to process the claim properly. For this reason, it is necessary for medical billing and coding professionals to receive training and preparation they need to be successful on the job.

Medical billing and coding workers are the health care professionals in charge of processing patient data such as treatment records and related insurance information. Medical insurance billers and coders are tasked with coding a patient's diagnosis along with a request for payments from the patient's insurance company.

The health care industry depends on skilled, qualified medical insurance billers and coders to accurately record, register and track of each patient's account. Medical billing and medical coding are actually two distinct jobs. So we'll discuss each separately.

Medical billers are really in charge of making sure everyone is being billed correctly. Some of this involves talking with patients and/or health insurance companies on a regular basis to make sure all invoices are paid on time. The biller should understand coding language and how to read medical invoices. This is perfect for someone who wants to have a balance of working with people (on the phone) and also spending time assessing invoices and data.

Medical coders, on the other hand, really don't have too much interaction with insurance companies and patients. This job is perfect for someone who would prefer to spend time assessing and coding data. Every duty performed in a medical office has a particular code assigned to it and it needs to be coded properly in order for proper billing. The medical coder and biller often work together to make sure all invoices are paid properly.

Some smaller medical offices might have one employee handle both job functions, but many times these jobs are outsourced to a medical billing service that can handle both jobs.

What do medical billers and coders do?

Medical billing and coding specialists are largely responsible for making sure medical office revenue cycles run smoothly. When a service is performed, a code is assigned to a bill. Coders must be productive and accurate.

Many medical insurance billers and coders work in cubicles of an office setting. They may work with equipment such as computers, printers and telephones, generally in a health care facility or agency. The hours can vary from a usual 40-hour workweek to part-time schedules, and in some cases there?s the opportunity to work extra hours for extra pay. You should confirm these work schedule options with any employer prior to applying for work as a medical biller or coder.

Some positions combine billing and coding responsibilities, along with helping patients. The size of the organization where you work will be the main factor in determining whether the position will blend typical medical insurance billing and coding duties and contact with patients. Keep in mind, working with patients can be challenging, as many times they are sick, contagious and short on patience!

What abilities does a person need to work in the profession?

Accuracy is extremely important. You should have an eye for detail, be a team player and possess a professional attitude. It is also helpful if you feel comfortable working with a computer. Always be willing to learn.

Why Choose Medical Billing and Coding?

There are a number of reasons to choose any career field -- most of them personal -- but here are a few top reasons why many people choose this rewarding profession:

  • It involves organization and detail-oriented work.
  • It does not require direct contact with patients or bodily fluids.
  • It's an easy transition from other fields, like the insurance or mortgage industry.
  • You can complete your training quickly and be working in the field in as little as one year.

International Classification of Diseases (ICD)

What is ICD?

International Classification of Diseases (ICD) is a common language that compiles, reports and uses health care information. The World Health Organization (WHO) periodically upgrades the ICD.

What is ICD-10?

ICD-10 is the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD). This is the reporting system for morbidity statistics and mortality stats. It has been the requirement since 1999 and will be updated Oct. 1, 2013.

How do ICD-9 and ICD-10 codes differ?

Unlike the codes in ICD-9, ICD-10 codes are alphanumeric. These new codes will require compatible billing software and will employ data that provide more information about a patient's condition.

Where can I get more information about the ICD-10-CM?

http://www.cms.gov/ICD10 is an excellent source of updated information.

Will current coders need to be retrained to use ICD-10?

Yes. This presents an opportunity for coders to upgrade their training. Taking the ICD-10 aptitude test is a requirement for anyone looking to confirm his or her ability to code with accuracy.

Why prepare for ICD-10?

You can prepare now for the changes in the health care system that will affect every area of medical reimbursement.

Training

What training do you need to work in medical insurance billing and coding?

Knowledge of medical terminology is very important for reading and grasping the contents of a patient's chart. Reading a chart entails knowing the procedures applied and the reasons why. In order to grasp the medical terms and medical billing codes, most employees in the medical billing field need to have training and education from either a career school or local college.

If you are interested in training for a medical billing career, you should seek out a program that includes:

  • Medical Terminology and Anatomy
  • Medical Billing Software
  • Medical Documentation Evaluation
  • Government Programs
  • Basic Math
  • Keyboard and Computer Skills
  • Administrative Duties

Medical billing and coding training programs may have students practice preparing insurance claims using manual and electronic methods. A good program will also teach you valuable interviewing and documenting skills.

You should make time to do proper research on any school before enrolling in a medical billing and coding program.

Are online classes legitimate?

There are many good, legitimate online courses and some that are not legitimate. Coding can be hands on, and learning online may be more difficult for some people. Investigate any courses of interest thoroughly before you enroll.

The Job

What is in a medical insurance biller coder's tool kit?

You will need a computer, coding reference books or lookup tools and coding software. Employers may supply necessary or additional materials.

Where do medical billing and coding specialists work?

Medical insurance billers and coders are not limited to the following venues but may work in physicians' offices, ambulatory centers, emergency rooms and insurance companies.

Is it true that medical billers can work from home?

As mentioned above, there are a bunch of scams that advertise medical billing jobs where you can work at home. It's actually very difficult to work at home - especially when you're just getting started. Working at home requires a solid client base that takes years of experience working in this field. If you plan on working as a medical biller, don't have your hopes too high on working at home because that's very rare.

How much do medical billing clerks earn?

Education, experience and industry certification play a big role in how much a medical insurance biller or coder earns.

According to the U.S. Bureau of Labor Statistics, as of May 2010 the median annual wage for medical records and health information technicians was $32,350. The lowest 10 percent earned less than $21,240, and the highest 10 percent earned more than $53,430.*

What are some other jobs medical billers can do?

The training received from a medical insurance billing and coding course may give you the skills to work in bookkeeping or payroll or as an accounting clerk or medical administrative assistant. This will, of course, vary depending on your education and experience.

Certification

What is the standard certification for an individual just beginning in the industry?

While there are several types of credentials that an individual can become certified in, the Certified Professional Coder (CPC) and the Certified Coding Specialist (CCS) are popular choices.

What qualifications should a certification class instructor possess?

Anyone teaching a certification course should be certified by the AAPC or AHIMA. While this is not a requirement, it is often found that certified instructors have a higher success rate when helping others prepare to earn their certification.

Are there certifications that employers do not recognize?

There are a number of certifications available through numerous organizations, but that may not be recognized by employers. If you are serious about your career in medical insurance billing and coding, you should consider obtaining certification through the AHIMA or AAPC.

Got another question? Please contact us and let us know what you'd like to ask!

*Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, 2012-13 Edition, Medical Records and Health Information Technicians, on the Internet at http://www.bls.gov/ooh/health care/medical-records-and-health-information-technicians.htm (visited July 06, 2012). Publish Date: Thursday, March 29, 2012.

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