Medical Billing & Coding Career and Education Overview
Medical coding and billing is 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 details of the job exist in two parts, as the duties involved with coding are quite different from that of billing. Often, these are two completely separate jobs, although smaller health care facilities generally combine them into one position.
What is a Medical Coder?
This 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:
1. 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.
2. 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).
3. 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 be presented to the World Health Assembly for endorsement in May 2018.
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 is the Job Description?
Coding duties 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).
Billing covers a variety of administrative tasks, but the main purpose is to handle the insurance processing and billing for all health care services, consultations, procedures, supplies, medications, etc. Some 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 Kind of Education is Required?
A post-secondary education is a must. However, the type of school and program you choose allows for some flexibility.
Although an associate degree tends to be the general standard within the industry, many 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. That's why a specialized diploma or certificate from a vocational school is so valuable. Vocational schools tend to focus specifically on preparing graduates who are job-ready for entry-level positions.
Another option is to complete an associate-level degree, or higher, in business administration, health information systems, or another related area, and follow it up with a medical coding and billing certificate or diploma course. By following up your degree with a short-term, career-oriented 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.
What Will I Learn in a Medical Billing Training 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 are Most Programs?
The length of medical billing and coding programs depends entirely upon the level. Associate degree programs are generally two years, while bachelor's programs can take up to four years.
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 medical billing and coding programs that can be completed in as little as two months are also available.
Is Medical Coding Certification Necessary?
Certification is not legally required to obtain a job in this field. However, some employers may prefer that candidates possess this qualification because it can demonstrate that you have met industry standards. Plus, statistically, those who are certified 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 150,000 medical billing and coding professionals to date.
The AAPC offers certifications related to various areas of the profession, including:
- Physicians' offices—Certified Professional Coder (CPC®)
- Hospital outpatient facilities—Certified Outpatient Coder (COC™—formerly 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 over 20 different specialty certifications available, which range from general surgery to internal medicine to pediatrics.
What is the Certification Cost?
The general examinations from the AAPC are $350. The fee is non-refundable, but you will have one full year from the date of purchase to take the exam. The specialty examinations cost $300 each and include one free retake.
What are the Available Jobs for Graduates?
There are many different jobs related to the field. Although most of the responsibilities remain consistent across all positions, the actual job titles can vary greatly. Some of the most common jobs for 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
What are the Most Common Workplaces?
Professionals in this field can find employment within various 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 these medical coding and billing 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 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 13 percent between 2016 and 2026. 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 Salary?
In a 2015 survey of almost 18,000 medical billing and coding professionals, it was discovered that those who were certified with at least one credential in this field earned an average salary of about $46,899. That's an increase of more than two percent from the previous year's survey. So wages are trending higher year over year. Plus, more credentials typically leads to a higher salary. Professionals with two credentials reported an average salary of $58,399 and those with three or more credentials earned $65,643 per year, on average.**
Your work setting also directly impacts your salary. Here is a breakdown of the average annual salary by type of workplace:
- Health system workplaces—$51,389
- Hospital inpatient settings—$50,925
- Large group practices—$48,033
- Hospital outpatient settings—$47,773
- Solo and small group practices—$45,722
- Medium-sized group practices—$44,870
Certain credentials also come with higher salaries. For example, Certified Physician Practice Managers (CCPM®) earned an average of $64,666 in 2015, which was a 6.7 percent increase from the previous year.
What Are the Benefits of the Job?
The top ones include:
- Personal satisfaction. It can be extremely fulfilling to know that your work has a huge impact on the health care industry. Not only are you helping patients and fellow health care professionals, but you also make it possible for national and international organizations to gather vital data and statistics.
- Excellent job prospects. Since the field is growing at a fast pace, you could have the opportunity to choose from a wider range of open positions. This means you could be more selective about the jobs you apply for.
- Good earnings. Specialists in this field typically enjoy good wages, especially considering that the education requirements are usually only two years or less.
* Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, web site last accessed on January 2, 2018.
** American Academy of Professional Coders (AAPC), web site last accessed on February 18, 2016.