What is Medical Billing and Coding?
When you receive a bill from a hospital or healthcare provider, it includes codes for the services performed. Medical coding translates medical reports and health information into standardized codes used by healthcare providers and insurance companies. Medical billing involves submitting these coded claims for payment. Specialists in billing and coding need to understand medical records, coding systems, and billing processes. As standards evolve, professionals like certified coding associates (CCA) and health information technicians must continue their education and training.
For those interested in this field, choosing the right medical billing and coding training program is key. Many accredited schools and online courses offer certifications, preparing students for exams and equipping them with the skills needed for the healthcare industry. Whether pursuing a diploma, associate degree, or certification, enrolling in an accredited program is the first step toward a successful career in this growing field.
A medical billing and coding specialist or health information technician often works in an office setting, though many professionals also work remotely, handling diagnostic coding and tracking patient health information from home. While medical billers and coders typically have separate roles, smaller offices may combine both tasks into one position. These specialists can work in various healthcare environments, including insurance companies, government agencies, and health information technology firms. Since most of the work is computer-based, professionals in this field must be comfortable with desk work.
For those seeking to enter the medical billing and coding field, training programs are available to equip students with the necessary skills to succeed in both remote and in-office roles. Whether working in healthcare settings or for insurers and data management firms, trained specialists play a crucial role in the accuracy and efficiency of the medical billing and coding process.
The US Department of Labor’s Bureau of Labor Statistics (BLS) projects a 9% job growth for medical records specialists from 2023 to 2033. As the largest industry in the nation, the healthcare sector, fueled by an aging population, continues to drive demand for medical billing and coding professionals. Prospective students can find medical billing and coding programs at community colleges, technical colleges, and universities, with options like associate degree programs or certification courses. These programs cover a range of subjects, including anatomy, health information technology, medical insurance, medical terminology, and diagnostic coding. Students can also opt for online programs, which prepare them for entry-level positions across the US.
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 often used interchangeably, they refer to closely related but distinct processes. Coding involves translating medical information, such as diagnoses or prescriptions, into standardized codes for billing purposes. There are thousands of these codes, each corresponding to a specific illness, injury, or procedure. For example, when a patient visits the doctor, a nurse may conduct tests, followed by the doctor’s examination, diagnosis, and treatment plan. Each of these actions is assigned a code. The medical coder then translates the visit into a list of codes for billing. International Classification of Diseases (ICD) codes are used for illnesses and injuries, while Current Procedure Technology (CPT) codes correspond to the treatments and services provided. Each code set has its own regulations and placement guidelines on invoices.
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 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 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 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.