Medical Billing and Coding Career Information
hen people think about jobs in the health care field, it can be easy to assume that
most jobs involve direct, hands-on patient care. What many people don't realize
is that administrative jobs are equally vital to ensuring quality health care services.
Medical billing and coding is an important piece in the administrative puzzle that
makes up the vast health industry.
What is Medical Coding and Billing?
So, what is medical coding and billing? The short answer is that it's a two-part job that involves applying codes to represent the treatment and medication received by a patient, submitting pertinent information to an insurance provider, billing the appropriate source, and following up until payment has been received for all rendered services.
The long answer must be split into two parts, as the duties involved with medical coding are quite different from that of medical billing. Often, these are two completely separate jobs, although smaller health care facilities generally combine them into one position.
What is a Medical Coder?
The long answer to the question "What is a medical coder?" is someone who takes the written or orally narrated notes and descriptions of doctors and other health professionals and applies a sophisticated coding system in order to convey the necessary information to insurance companies. They also help provide the uniformity that makes it possible to compile accurate data for studies, statistics, etc.
There are three main types of coding systems currently used within the industry:
- Current Procedural Terminology (CPT)
- Managed, maintained and copyrighted by the American Medical Association (AMA).
- Thousands of codes in use.
- Updated annually in order to remove obsolete codes and add new codes.
- Annual update handled and overseen by AMA editorial boards, who also distribute new versions of books, manuals, and software.
- Healthcare Common Procedure Coding System (HCPCS)
- Codes designed specifically for Medicare and Medicaid services.
- Based on CPT codes.
- Ensures uniformity for all Medicare and Medicaid customers.
- Monitored by the Centers for Medicare and Medicaid Services (CMS).
- International Statistical Classifications of Diseases (ICD)
- Created, monitored, and copyrighted by the World Health Organization (WHO).
- Changes and modifications in the U.S. are overseen by the National Center for Health Statistics (NCHS), which is part of the CMS.
- Used to help create uniformity in the classification of symptoms, diseases, abnormal findings, and causes of injuries and diseases, which are used to compile international morbidity and mortality statistics.
- New versions created as necessary. ICD-10 is the current standard, although the U.S. was slow to change to the new system, so ICD-9 is still followed in some health care environments.
- The first draft of ICD-11 was distributed in July 2011, and is expected to receive official endorsement from the WHO by 2015.
What Do Medical Coders Do?
Although the basic premise of medical coding has been covered, you may still be
"What do medical coders do?"
The actual duties of a medical coder include:
- Reviewing written or oral notes from physicians and other health professionals to identify the procedures, services, and medications a patient received.
- Following up with physicians and health professionals as necessary for clarification of services, procedures, and diagnoses.
- Applying corresponding codes to the information provided by the patient as well as the diagnosis and treatment provided by health professionals using the appropriate coding system (CPT, HCPCS, or ICD).
What is a Medical Biller?
Medical billers essentially act as a vital link between health professionals, patients, and insurance companies. They are responsible for taking the coded information from each patient's visit to a health facility, preparing a claim, and submitting the claim to the proper source—usually an insurance company or the U.S. government via Medicare or Medicaid. They also handle the follow-up for claims, tracking progress and making contact with the appropriate parties until the health care bill has been paid in full.
Because health insurance is available from various sources, medical billers must have a strong knowledge of many different types of insurers as well as the related billing processes and regulations. This can include:
- Commercial claims
- Blue Cross
- Blue Shield
- Workers' Compensation
What Do Medical Billers Do?
Medical billers handle a variety of administrative tasks, but their main purpose is to handle the insurance processing and billing for all health care services, consultations, procedures, supplies, medications, etc. Some of their specific duties include:
- Processing and filing insurance claims.
- Providing customer service to patients or companies with questions surrounding a claim or a bill.
- Following up on claims that haven't received a response.
- Contacting patients and insurance companies about claims that are in review, pending, or denied.
- Preparing and sending monthly bill statements.
- Turning delinquent accounts over to debt collection agencies.
What Qualities Do Medical Coding and Billing Professionals Need to Have?
As with most administrative jobs, medical coding and billing professionals need to have excellent attention to detail, as one wrong code or inaccurate statement can have an extremely negative impact on a health care facility. A good head for numbers is also an obvious requirement since the majority of the job involves working with codes and numbers. Customer service is another vital skill in this industry because it is a common occurrence for medical billers and coders to communicate with patients and insurance companies to answer questions, clarify information, and request payments.
Some of the more hands-on skills required by medical coders and billers include a working knowledge of computers, and the ability to work with general business software applications as well as industry-specific software. Strong accounting skills are also a must-have since medical billers are partially responsible for the financial aspects of a health care facility.
A few of the personal traits that can lend well to a career in medical coding and billing include:
- Patience. Dealing with medical bills can be stressful on patients and their families, and it can be upsetting to hear that insurance doesn't cover certain procedures, medications, etc.
- Compassion. You will often have to interact with patients and families who are dealing with serious illnesses or injuries, and a little compassion and understanding can go a long way to ensuring a more positive experience for everyone involved.
- The ability to manage stress. A high rate of burnout is attributed to professionals in the health care industry due to high work demand, long hours, and stress. Being able to manage stress effectively and knowing when and how to say "no" to an unreasonable work demand can help prevent burnout, minimize stress, and allow for career longevity.
What Kind of Education is Required for Medical Coders and Billers?
Are you wondering how to be a medical biller and coder? If you are considering medical billing and coding for your career future, it's helpful to first gain a solid understanding of the requirements. A post-secondary education is a must. However, the type of school and program you choose allows for some flexibility.
These types of programs can be available in a variety of different degree options, such as associate, bachelor's, or even master's. Depending on the program level, they can include business, health care, and technology-related subjects, as well as a variety of general education options. General education courses can give you the opportunity to complement your hands-on career-related training with important general skills and knowledge, such as critical thinking, teamwork and team building, problem solving, decision making, and more.
Another option is to complete a degree in the discipline of your choice and follow it up with a medical coding and billing certificate or diploma course. Because most employers' educational requirements involve at least an associate degree, it may be helpful to achieve this level of education, regardless of the discipline you choose. By following up your degree with a short-term, career-oriented medical coding and billing program, you can then add to your educational background with job-specific, hands-on training and could even have the chance to gain real-life experience through an externship, clinical, or practicum.
Although an associate degree tends to be the general standard within the industry, some employers may consider applicants whose sole post-secondary education is a specialized medical coding and billing diploma or certificate from a career school. Although some on-the-job training will always be necessary, career schools tend to focus specifically on preparing graduates who are job-ready for entry-level positions (and some employers may appreciate a candidate who has the ability to make a smooth transition from school to the workforce with minimal on-the-job training).
What Will I Learn in a Medical Billing and Coding Program?
Since degree and diploma programs from career schools tend to be more to-the-point, focusing on specific career-oriented and industry-standard skills, the curricula generally consists of three areas: theoretical background, hands-on training, and real-life experience and preparation.
The three general areas and specific topics of training can include:
- Theoretical—general health care concepts, medical terminology, medical coding systems, health insurance basics
- Practical—medical coding, insurance processing and billing, medical records maintenance, industry-related computer software, general administrative duties
- Real-Life—externship, practicum, or clinical, preparation for industry certification examinations
How Long is Medical Billing School?
The length of programs depends entirely upon the level. Associate degree programs are generally two years, while bachelor's programs can take up to four years. Medical coding and billing diploma and certificate programs are meant to be short-term, allowing you to graduate and enter the workforce quickly. Therefore, they are typically around one year in length, although some programs can take up to two years. Online programs are also available that can be completed in as little as two months.
What is the Medical Billing and Coding Training Cost?
The cost of medical billing and coding programs can vary depending on the type and length of the program.
The tuition for medical billing and coding associate degree programs averages around $32,000. The cost of tuition for certificate and diploma medical billing and coding programs is generally much lower—usually between $12,000-18,000. Some programs include books and supplies in the tuition, while others do not. Typically, books and supplies total around the $800 mark.
Programs that are accredited by the Commission on Dental Accreditation (CODA) are typically designed to take about nine to 11 months to complete.
Is Certification Necessary for Medical Billing and Coding Jobs?
Certification is not legally required to obtain a job in medical billing and coding. However, some employers may prefer that candidates possess this qualification because it can demonstrate that your skills, knowledge, and abilities have met industry standards. Plus, statistically, certified medical coders and billers earn a higher salary, on average, than non-certified workers.
The most common certification in the field is offered by the American Academy of Professional Coders (AAPC), which was founded in 1988 and has certified over 78,000 medical billing and coding professionals to date.
The AAPC offers certifications related to various areas of the medical billing and coding profession, including:
- Physicians' offices—Certified Professional Coder (CPC®)
- Hospital outpatient facilities—Certified Professional Coder-Hospital Outpatient (CPC-H®)
- Payer perspective coding—Certified Professional Coder-Payer (CPC-P®)
- Interventional radiology cardiovascular coding—Certified Interventional Radiology Cardiovascular Coder (CIRCC™)
- Medical auditing—Certified Professional Medical Auditor (CPMA™)
- Medical compliance—Certified Professional Compliance Officer (CPCO™)
There are also 20 different specialty medical coding certifications available, which range from general surgery to internal medicine to pediatrics.
What is the Medical Billing and Coding Certification Cost?
The general medical billing and coding examinations from the AAPC are $300. The fee is non-refundable, but you will have one full year from the date of purchase to take the exam. The 20 specialty examinations cost $245 each and include one free retake.
What are the Available Jobs for Medical Billing and Coding Graduates?
There are many different jobs related to the field of medical billing and coding. Although most of the responsibilities remain consistent across all positions, the actual job titles can vary greatly. Some of the most common jobs for medical billing and coding graduates include:
- Medical coding and billing specialist
- Medical billing clerk
- Billing coordinator
- Medical claims analyst
- Electronic claims processor
- Reimbursement specialist
- Claims assistant professional
- Patient account representative
Where Do Medical Billers and Coders Work?
Medical coding and billing professionals can find employment within a wide range of health care settings. While larger facilities may separate coding and billing into two separate jobs, smaller health care environments often combine the separate duties into one position. Some of the places that employ medical billing and coding professionals include:
- Physicians' offices
- Health clinics
- Long-term care facilities
- Dental offices
- Home health agencies
- Nursing homes
- Health insurance companies
- Ambulatory services
What is the Outlook for Medical Billing and Coding Jobs?
For the purpose of statistics,* medical billing and coding is placed within the larger category of "medical records and health information technology." This segment of the health care industry is expected to grow at a rate that is described as "much faster than the average," with job prospects being rated as "very good."
To be more specific, this field is projected to grow by 20 percent between 2008 and 2018. This is attributed to various factors, including an aging population and a rise in the number of medical treatments, procedures, and tests that are routinely performed.
What is the Average for Medical Billing/Coding Salaries?
In an online survey** of more than 10,000 medical billing and coding professionals in 2010, it was discovered that certified employees saw a salary increase of 1.5 percent from the previous year, bringing the average salary to $45,404. Non-certified employees also saw a rise of 1.2 percent, though at $37,746, the average salary was slightly lower than that of certified medical billing and coding professionals.
Medical billing/coding salaries are also directly impacted by experience. The more years of experience, the higher the salary tends to be. Here is a breakdown of the average annual salary of certified medical coding and billing professionals by years of experience:
- 1 Year—$34,551
- 5 Years—$40,638
- 10 Years—$45,683
- 15 Years—$50,307
- 20 Years—$51,563
- 25+ Years—$53,669
The highest average salary was found to be that of experienced medical billing and coding instructors, who may also work as consultants outside of teaching. The average annual salary for these professionals was $69,207.
If, after learning the who, what, and where of medical billing and coding, you are interested in finding out more about pursuing a future in this field, then check out this guide to medical billing and coding schools for the option to request more information today.