What Is Medical Coding and Billing?

If you look on a medical claim form you will see that no longer are words required, and these days what a doctor does will be seen on the claim form as a series of codes. Medical coding and billing, contrary to what most people think, are two different disciplines. It isn’t about a medical biller and coder; instead you get a certified coding specialist and you get a medical biller.

They work very closely together, each holding different responsibilities. The two positions interact with each other, and the job of medical billers and medical coders is in high demand in the health care industry. The health care industry has grown in leaps and bounds, and support jobs such as medical assistants and medical billers and coders are very popular for young people looking for jobs in the medical industry.

Medical Coding and Billing for Efficient Running Health Care Industry

When we see administrative people working in hospitals and doctors’ offices, little do we realize what goes on behind the scenes to ensure that the health care industry runs smoothly and efficiently. Medical coding and billing professionals play leading roles in the health care process. They both work in the field of medical administration, and both can get their training and certifications through the same courses. When it comes to looking for a job, employers who hire them give preference to those who have graduated from a medical billing and coding school and who are certified.

Medical billers for instance, are not required by law to become certified, but they are advised to become certified by taking an exam such as the CMRS Exam and the RHIA Exam. Those seeking advancement in the field will want to attain a bachelor or master’s degree. Coders with this type of education can eventually advance into health information management positions. Anyone wanting to advance in this field will want to go for a bachelor or master’s degree because this opens doors to health information management positions. Training equips the medical biller and coder with medical procedures and they will get to know how to interpret procedures into billing codes.

Standardized Coding Used Around the World

The operator needs this specialized training so that they are familiar with the human body, pharmacology and the CPT coding system, bearing in mind that this coding system is used all over the world. Each diagnosis gets a code which translates into a billing amount. The classification software will determine how much health insurance companies will be billed for the services. Programs take two years to complete, of which maths and science are part of the course, and of course proficiency with computers and other technology is essential.

Coding Used in Many Areas of Medical Industry

Statistical reporting is done using medical codes. Reports for the number of motorcycle accidents for instance, come from medical coding statistic which are reported to health care agencies. Also, clinical research gives medical professionals an idea of how to treat patients, and medical coding provides information used in clinical research and codes connected to certain illnesses for instance, are reported in order to assist researchers with understanding certain pattens and where more research and medical efforts are required.

Of course medical billing and coding professionals can decide to specialize and deal with cardiology for instance. Cardiology registrars maintain databases of people with heart problems, review the patient’s record and then assign codes for treatment. The registrars track the treatment as well as the recovery rates of patients within the registry.

Job Outlook for Medical Coders and Billers

The job outlook for medical codersMedical Billing and Coding and billers looks pretty good simply because in the world we live in, accidents, injuries, old age and stress are seeing more and more people visiting doctors, which ultimately leads to more bills. Those with medical billing and coding information with excellent skills in computers and technology are going to be in high demand, according to the Labor Department, and with the advent of electronic record systems, you have to be highly trained to do this job.

Medical billing and coding professionals stand to earn substantial salaries. Medical billing and coding salaries will vary due to a number of factors, but will average around $50,000 per year in the United States. Your salary will be determined by factors such as the experience you have, your credentials, your exam scores as well as the type of employment you have. To maximize your chances of the highest pay possible in the medical billing and coding field, make sure that you acquire a specialized credential, and go for a degree rather as opposed to a certificate.

Medical Billing

Medical billing is the process followed to secure payment from patients’ insurance companies. It involves the conversion of medical codes into specific terminology which is required by the insurance provider. The medical coder will assign codes , and the responsibility of medical biller is to translate the codes for the insurance companies so that the billing documents can be sent out. The duties of the billing specialist are:

  • to translate codes and prepare the appropriate claims documents for the insurers – medical billers have to be super efficient and accurate because a mistake can cost thousands of dollars to the insurance company, patient or hospital.
  • submit and track all insurance claims
  • do follow up to ensure payment is received and also manage collections if necessary

Medical Billing can be provide from any location; it is not necessary to be in the doctor’s office, and it is for this very reason that medical billing business ownership is so sought after, particularly because doctors are opting to outsource their medical billing.

Medical Coding

Medical Coders are known by a few names including Coding Specialists or Health Information Technicians. Medical coding is when the assigning of specific alpha numeric codes are assigned to various billable services. The codes are used to ensure that medical records are accurate and that their content is clear to anyone who uses them.

Each time a patient receives medical attention at a doctor’s room, clinic or hospital, the services are documented, after which the coder will separate the information from the documentation, allot the appropriate codes and then create a claim to be paid. They are in fact responsible for a range of tasks surrounding the management of records for all billable transactions. Their duties generally include:

  • entering codes into management software
  • reviewing doctor’s notes and charts for accuracy
  • getting clarification of information on notes and charts
  • assigning medical codes to all diagnoses or services
  • ensuring all medical records are signed

The medical coder needs to know and be familiar with the ICD-9-CM, ICPM, DSM-IV and CPT-/HCPCS universal coding systems. These numeric systems provide a description of the patient’s condition as well as services offered by the health care provider. The numeric systems are such that misinterpretations by people regarding conditions and treatment can be eliminated.

What is Medical Billing Software?

Anyone from a billing specialist to a medical transcriptionist has the knowledge of the medical billing software because it is this software that they enter in their codes in order to bill for payment. The transcriptionist works on a medical billing software program that deals only with the coding aspect and not the payment aspect.

The medical billing software programs help the billing staff to enter in the codes which are then tagged with services. Each code has a different number and the numbers are all 5 digits long. An example would be the code 99204 which is a comprehensive office visit done by the doctor with no complications. This one number tells what the service was and when it is entered into the medical billing software, a pre-filled database of charges will assign a charge to that code and that is what will be sent to the insurance company for payment.

The medical billing software program is equipped with databases that include the patient information and history, the medical billing codes that are used for that particular medical practice, and the charges that are assigned to each service. Most of the work is already done for the billing specialist, as they will just have to use the medical billing software in order to input all of the relevant information.

The software program will also generate the proper forms that are mandatory for the insurance company to accept electronically. There are times when there has to be paper billing due to possible billing mistake or a rejected claim that has to be sent in on appeal or a smaller insurance company that is not yet set up on electronic billing.

Medical Coding and Billing Certification Programs

There are many medical billing and coding schools and online programs offering a wide range of programs; providing you with plenty of opportunities to select from the best schools and the right programs that are guaranteed to meet all your goals. Students will spend considerable time learning the classification systems and software which is the tool they will use throughout their career as a medical biller or medical coder.

The most important thing is to make sure that you choose an accredited program. A good accredited school will offer detailed courses that cover topics on anatomy, patient rights, legal aspects, health insurance claims, medical terminology, electronic data management, legal aspects and pharmaceutical products, and students will participate in both theoretical and practical training at colleges or universities.

The medical biller will want to earn the recognized CMBP (Certified Medical Billing Professional) because there isn’t another course that can offer or prepare a billing professional as well as this course with instruction coming from medical billing professionals. You will also get hands on experience by applying your knowledge to a fully functional medical billing software. With medical billing training you will be entering patient data, posting charges and payments, running reports and creating CMS 1500 forms.

Medical Billing Course.com is aMedical Coding wonderful resource for those who want training in medical billing. They are nationally recognized, offering programs that vary in price depending on your needs. Their billing course takes about 60 hours to complete although students can study at their own pace. Once the course is complete, students can take their exams on-line and have results from a grader within 24 hours. With Medical Billing Course.com, all their instructors and forum moderators are highly experienced in medical billing, and they provide telephone, email, as well as a 24 Hour Online Student Support Forum.

Online medical billing as well as online coding courses provide students with all the training they need to enjoy a career in the medical billing and coding field. Educators have developed outstanding programs for students who want to study from their own computers at home. On-line medical billing and coding courses offered by the different coding and billing schools is similar to the training students would have when enrolled in a traditional associate’s degree program. Some of the training material in these courses will include:

  • managed care terms
  • rejections and appeals
  • collections
  • procedures for filing medical insurance claim forms
  • fraud and billing abuse
  • what is medical coding

For people wanting to start their own business and who want to understand the MBAC field so that they can work from home, there are also online medical billing and coding courses which offer training for running your own business.

Some excellent online medical billing and coding courses:

  • Laurus College – they offer programs for careers in web design, computer and information technology, business, and medical billing fields.
  • National American University – medical administrative assistant, health care coding, electronic health record support specialist
  • University of Phoenix – this university has more than 200 locations, and offers online programs to countries all over the world. Their programs are, amongst others, B.S. in health administration/health information systems
  • Penn Foster Schools also offer distance education programs in medical coding and billing as well as medical administrative assistant

AAPC at aapc.com is the largest training and credentialing organization for the business side of medicine. Medical Billing and Reimbursement Course for instance provides the most up-to-date information relating to Medicare and third-party billing and the student will study everything they need to know about the health insurance industry. Upon completion the student will be prepared to work in a medical billing department at a physician’s office. When you enroll for the course, you will get your textbooks, workbook and audio lectures as well as a certificate on completion.

In Closing

There is no denying that medical coding is complicated, but it is fundamental, being required for reimbursement by insurers. The whole process requires a lot of accurate and detailed collection of information as well as proper data entry and follow up. The Current Procedural Terminology, developed and maintained by the American Medical Association, is the medical diagnostic procedures and services which are performed by physicians as well as other health providers. There are thousands of service codes as well as rules on how they are to be used.

Because medical professionals normally would use different terms to describe illnesses and treatments, a standardized way was needed to report them, and this medical coding allows for this standardization. The medical codes create uniformity for procedures; for instance cotton wool used at one hospital will have the same medical code as cotton wool used in another hospital in another part of the world.

Healthcare institutions can really benefit by outsourcing to a medical coding and billing company and save themselves a lot of time and effort because these billing companies have all the expertise to ensure health care institutions don’t lose out because of under coding and missed charges. The medical coding and billing company adjusts their services to the needs of all their clients and have trained specialists with expertise on coding as well as the advanced software they use to ensure quick and efficient coding.