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Home > Medical Billing Resource Center > Medical Billing And Coding Profession

Medical Billing And Coding Profession
by Danni R., CMA, CCMA, CMAA


Medical Billing and Coding Net - http://www.medicalbillingandcoding.net
Reference site for medical billing and coding specialists and students offering career and certification advice, learning resources, and networking opportunities between medical billers and coders.

Medical billers and coders are in high demand among the allied health occupations. According to the US Bureau of Labor Statistics (BLS), health information technicians are one of the 10 fastest-growing allied health occupations. It is a challenging, interesting career where you are compensated according to your level of skills and how effectively you use them.

Medical billers and coders know this and feel good about the support they provide to physicians, clinics, hospitals, and patients. They know they play an important role in the business office where they are employed. Their work consists of submitting the proper documentation to a number of insurance companies and federal agencies for reimbursement in order for their employer to financially succeed and avoid fraud charges. Their specialized training and expertise lets them find work any place, any time. Numerous opportunities for trained individuals exist in medical offices, clinics, hospitals, insurance companies, and in form of freelance home-based businesses. Advancement opportunities are unlimited!

The U.S. Department of Labor states that continued employment growth for medical coders and billers is spurred by the increased medical needs of an aging population and the number of health practitioners. The Occupational Outlook Handbook reports that earnings vary widely and pay levels are governed chiefly by experience and qualifications.

Healthcare Careers Offer Job Security, Personal Satisfaction, Challenges, and Rewarding Experiences

Many interested in a career in the healthcare field decide to specialize in the medical billing and coding profession. Medical billers and coders are no longer restricted to only the doctor's or dentist's office but are now working in hospitals, pharmacies, nursing homes, mental healthcare facilities, rehabilitation centers, insurance companies, health maintenance organizations (HMOs), consulting firms, and health data organizations, or even from home.

These highly skilled professionals are earning impressive wages everywhere they are. Typical duties of medical billers and coders include:

  • Explaining insurance benefits to patients and clients
  • Office bookkeeping and other administrative duties
  • Accurately completing claim forms
  • Explaining insurance benefits to patients
  • Handling day to day medical billing procedures
  • Adhering to each insurance carrier's policies and procedures
  • Prompt billing of insurance companies
  • Documenting all activities using correct medical terminology
  • Scheduling appointments

Other job opportunities for medical billers and coders include:

  • Billing Specialist
  • Patient Account Representativ
  • Electronic Claims Processor
  • Billing Coordinator
  • Coding Specialist
  • Claims Analyst
  • Reimbursement Specialist
  • Claims Assistant Professional
  • Medical Collector
  • Claims Processor
  • Claims Reviewer

What is Medical Billing?

Medical billing is better described as medical practice management and a doctor's key to getting paid. Although most doctor's offices request that payment be made at the time a medical service is provided in order to minimize billing, every medical office has a need to maintain patient financial accounts and for collecting money.

In a small family practice or suburban clinic this task may be simple and assigned to the medical assistant or nurse but in bigger practices and clinics this is the medical biller's job!

Medical billers and coders usually work forty regular office hours from Monday through Friday on a desk in the billing office or billing department of the professional healthcare office. They must know the different methods of billing patients, understand various collection methods, ethical and legal implications, have a good working knowledge of medical terminology, anatomy, medical billing and claims form completion, and coding. They also must understand database management, spreadsheets, electronic mail, and possess state-of-the-art word processing and accounting skills, be proficient in bookkeeping, and be able to type at a speed of at least 45 words-per-minute.

The work area of medical billers and coders usually is in a separate area away from the patients and public eye. However, even though they are not involved in the actual process of doctors and healthcare professionals providing medical care they need to possess excellent customer service skills when it comes to making contact with clients, insurance companies, and often patients. Medical billers must know how to explain charges, deal with criticism, give and receive feedback, be assertive, and communicate effectively without becoming confused as the person is asking questions. Patients can quickly become frustrated when trying to deal with healthcare providers and bills over the phone.

While an increasing amount of patient care is being funded through HMO related insurance, where the patient makes a small copayment at the time of service and the doctor bills the managed care company for the balance, a number of patients still need to make arrangements to pay for their medical services over a period of time. Part of the medical biller and coder's job is to contact some of these patients from time to time regarding a past due bill. Incoming calls from patients who have questions regarding a bill are also directed to the medical biller's office. The way s/he communicates over the phone can make or break business relationships.

Other specialties closely related to the medical billing and coding profession are:

  • Medical Coders/Coding Specialists
  • Patient Account Representatives
  • Electronic Claims Processors
  • Billing Coordinators
  • Reimbursement Specialists
  • Claims Assistant Professionals
  • Medical Claims Analysts
  • Medical Claims Processors
  • Medical Claims Reviewers
  • Medical Collectors

What is Medical Coding?

Every healthcare provider that delivers a service receives money for these services by filing a claim with the patient's health insurance provider or managed care organization. This is also referred to as an encounter. An encounter is defined as "a face-to-face contact between a healthcare professional and an eligible beneficiary."

Codes exist for all types of encounters, services, tests, treatments, and procedures provided in a medical office, clinic, or hospital. Even patient complaints such as headache, upset stomach, etc. have codes which consist of a set of numbers and combinations of sets of numbers. The combination of these codes tells the payer (health insurance companies or government entities) what was wrong with the patient and what services were performed. This makes it easier to handle these claims and to identify the provider on a predetermined basis. In addition, the services rendered (CPT) codes have to match the diagnosis (ICD) codes to justify medical necessity.

To do this correctly for each third party payer choices have to be made from a combination of 3 coding systems totaling over 10000 codes, and which change annually. In addition, a completely new coding system, ICD-10, is proposed for reimbursement purposes in the near future.

Tools of the Trade

CPT books provide all the procedural terminology and ICD-9-CM code books have the most up-to-date information on medical diagnosis coding. The medical coder must stay current on any new ICD-9 code changes that would impact code accuracy and claims submission. HCPCS books contain the complete lists of HCPCS Level II codes with descriptions. They will guide the medical coder through current modifiers, code changes, additions and deletions. HIPAA books help to develop an effective HIPAA compliance plan and DRG books are needed for Medicare's classification of inpatient hospital services based on principal diagnosis, secondary diagnosis, surgical procedures, age, sex, and presence of complications.

Training

Training of the medical billers and coders can range from two to four years of college, a technical school diploma, certificates from correspondence courses, to simple home study programs. Upon completion of such training many coders may seek professional certification.

Though not necessary, it is recommended and national associations are available for the certification processes.

Vocational Training

Professional medical billers and coders are in very high demand. Billing for services in healthcare is more complicated than in other industries. Government and private payers vary in payment for the same services and healthcare providers and organizations provide services to beneficiaries of several insurance companies at any one time.

Therefore, to reach proficiency in this business, basic training, clinical supervision and continued professional development is essential!

Typical Course Requirements are:

  • Medical Office Procedures
  • Medical Keyboarding
  • Medical Terminology
  • Health Structure and Function
  • Health Care Records Management
  • Medical Insurance
  • Survey of Pathology
  • CPT-4 HCPCS II, III
  • Healthcare Laws and Ethics
  • Basic Coding ICD-9-CM
  • Basic Pharmacology
  • Medical Transcription
  • Externship
  • National Exam
  • General Education Requirements

Professional Advancement Opportunities

A recent American Hospital Association survey showed that about 18% of billing and coding positions remain unfilled due to a lack of qualified candidates. Most companies and practices are looking for schooling and experience mostly because of the legal ramifications of incorrect billing practices.

However, medical billers and coders are also able to work independently out of their homes where they established a home based billing office. There are plenty of electronic billing programs available that can be set up through home office computers. Also, there is the possibility to become an independent insurance specialist or consultant who helps patients understand their insurance bills and what they should be paying.

Opportunities also exist as patient account managers, physician office supervisors and management, various types of personnel managers in the healthcare industry, health claims examiners, and medial billing and coding instructors. The more education the individual has, the more employment options are available and advancement opportunities become virtually unlimited!

Professional Certification

As in so many healthcare professions certification in the medical billing and coding field is not required but highly recommended. The days of the single family practice medical assistant or nurse typing out an invoice after office hours are history. Even the smallest offices and clinics have changed to computer billing because it offers greater coding accuracy, saves time, and can be used by administrators and auditors to ensure that visits are being coded to the appropriate levels which increases revenues.

Understandably, these offices and companies are looking for individuals who are certified in their field to ensure the employer that the individual whom they hire is competent and proficient.

There are numerous well known and well respected organizations sponsoring these types of examinations. Intersted candidates should research each one and find the one that most suits your needs: American Association of Medical Billers (AAMB) offers Certified Medical Biller (CMB) and Certified Medical Billing Specialist (CMBS) examinations. The National Association of Claims Assistant Professionals (NACAP) offer Certified Claims Assistance Professional (CCAP) and Certified Electronic Claims Professional (CECP). The examinations for Certified Procedural Coder (CPC), Certified Coding Specialist (CPS), Accredited Record Technician (ART), and Registered Record Administrator (RRA), are administered through the American Health Information Management Association (AHIMA). The National Healthcareer Assosciation (NHA) is offering their Medical Billing and Coding (CBCS) credential.

If your objective is to work for a medical office, group practice, healthcare provision network, or hospital as the medical billing and coding specialist keep in mind that most private practices, organizations and hospitals throughout the country not only prefer but often require national certification as a competency standard.

To learn more about this very rewarding career visit the Medical Billing and Coding Net web site at http://www.medicalbillingandcoding.net

© 2003 Danni R. of the Medical Billing & Coding Net. Reprint permission available by request.

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