It can be overwhelming for anyone new to medical billing and coding to understand all the jargons going around or to decide where to start. We have tried to create this page with the most frequently asked questions and answers to help beginners to the healthcare industry and medical billing and coding.
What is Medical Coding?
Medical coding is the translation of medical records about the patient from a doctor or hospital into standard medical alphanumeric codes used in the healthcare industry. A medical coder reads the medical documentation such as transcription notes and laboratory results in order to identify the applicable alphanumeric codes called diagnoses and procedure codes. Medical coding helps to identify the correct codes and creates a claim to be used in medical billing process. Medical coding requires the knowledge of standard healthcare codes such as CPT, ICD, and HCPCS in order to accurately create the claim.
What does a Medical Coder do?
Professional coders review the medical reports or transcripts for a patient visit such as a doctor’s report from a procedure or consultation, and then determines the appropriate codes to be used.
A typical day of a medical coder will start with heading to work which could be a physician’s office, group practice, hospital or other health facility or your own home if you are working from home. At work, a coder gathers medical notes and exam results from a previous visit and then translates them into medical codes. These translations may need additional research and consultations depending on the case being coded. This may include referring to the professional documentation or transcript, seeking guidance from lead medical coders, or sending queries to the physician, nurse and other health providers who created the original document. Once you have finished creating the coding, you would typically turn it over to the billing team. Medical coders are required to comply with the laws and regulations related to healthcare privacy while storing and handling health information.
What is Medical Billing?
Whenever you go and visit a doctor or another medical facility which is a provider of healthcare, the provider submits the details of this visit to your health insurance companies in order to receive payment for services rendered. Medical billing is the process of translating a healthcare service into a billing claim. The responsibility of the medical biller in a healthcare facility is to submit the claim usually coded by a medical coder and follow up with the payer to ensure the practice receives reimbursement for the service provided. A medical coder may also do the billing in smaller facilities even though it is considered as another function.
What does a Medical biller do?
The job of the medical biller typically begins where the job of medical coder ends. Medical biller creates the bills for the coded claims and sends them to patient’s insurance company or payer. If there are payments not covered by the payer, biller will send out billing letters and collect payments from patients.
A typical process for the medical biller is as described. The medical biller uses the codes identified by the medical coder and creates a medical claim in paper or electronic format. The biller must ensure that the codes are accurate and is usually a quality checker for the medical coder. In order to do this, a medical biller to be familiar not only with medical terminology, but also with the current forms of CPT, ICD and HCPCS codes.
Medical biller must also be familiar with the insurance company policy and benefits in order to determine if the procedures and services performed by the healthcare provider are covered by that patient’s plan. This will help to determine if codes and procedures listed on the claim is actually billable. Provider’s contracted rates with the insurance company, which may vary based on the insurance policy, also needs to be considered while creating the claim.
The medical biller creates and files the medical claim and then sends it off to the payer electronically or through manual forms. Depending on the insurance company processes, the claim may first go through a clearinghouse or to the payer.
Who do Medical Coders work for?
A medical coder could be employed by any facility that requires coding skills. A list of such facilities is below :
- a doctor’s office
- an outpatient hospital or a hospital network
- a billing company
- a healthcare insurance company
- Ambulatory Surgical Center (ASC)
- Urgent care
- Self-employed (work at home)
Can you work from home as a medical biller and coder?
Yes, medical billing and coding is a profession that can be a work from home career. There are many companies intereseted in work at home coding specialists rather than on-premise employees. Additional information on how to become a work at home employee can be found here and how to start a work at home medical billing and coding business can be found here.
Why become a Medical Coding Specialist?
It is a very good time to start a career in medical coding as more and more providers are using the coding to leverage and adhere to the healthcare claims processing standards and rules set by the government and the industry which has increased the demand for healthcare professionals with coding knowledge. Since jobs are plentiful and the average certified professional coder salary is rising, this is a great time to enter the career.Not only are there a large number of job openings in coding and billing, many of these jobs are fairly lucrative.
What does a medical coder make an hour?
Entry-level coders and billers made an average salary of $49,872 in 2016—that’s $24 an hour when you’re starting out. The field of medical billing and coding is growing as a result of a number of factors, chief among them being an aging population, an increasing focus on health data and information, and the digitization of health records. As the health care system turns increasingly to electronic health records, billing and coding specialists who are computer-savvy will have a leg up on the rest of field. For additional information check the AAPC and AHIMA salary survey results.
How do you become a medical coding specialist?
Certified professional coders must demonstrate a strong understanding of human anatomy and medical procedures and the rules and regulations that define how to code them in health records and insurance claims. You must demonstrate that you have:
- An understanding of anatomy, physiology and medical terminology — including evaluation and management, surgery, anesthesia, radiology and pathology.
- Extensive knowledge of CPT®, HCPCS Level II, and ICD-10-CM Volume 1-2 medical code for diagnoses and procedures.
- The ability to translate provider transcripts into accurate codes.
- The ability to quickly identify problems and query providers to ensure proper coding.
- Knowledge of medical coding guidelines and regulations governing reimbursement and compliance.
- Ability to keep current with medical coding and payment policy changes, and to ensure they are integrated into reimbursement processes.
How long you have to be in school to be a medical coder?
While not required, an associate’s degree is generally expected, and a bachelor’s degree is more desirable to employers. Any classes that focus on anatomy, physiology, disease processes and medical procedures can provide a good foundation to become a medical coder. Some colleges and universities provide training and certificates specific to the profession.
There are also both in-class and online private courses that focus specifically on medical coding, the details of which can be found in the learning section.
While coursework and years of industry experience can be enough for a successful career in medical coding, the Certified Professional Coder (CPC) certification is the most valued certification in the industry for a medical coder.
For those who want to move into management or other better-paid positions in the medical coding field, there are plenty of options, including:
- Advanced certifications are available in many specialty fields, from ambulatory surgery to urology and the certification increases job prospects and tends to command a higher salary.
- Medical coding auditing or management positions require more expertise and experience, but will yield significantly higher salaries.
For more information, check our guides on selecting a school for certification or diploma training or degree programs. If you are looking for schools that provide medical billing and coding classes near you, check the schools guide and select your state,
What is a Certification?
A Medical Billing or Coding certification usually involves certain coursework and an exam if passed entitles you with a credential that gives your future employers confidence that you have the skills needed to become a biller or coder.
There are several organizations that certify billers, coders, and other HIM professionals:
- AAPC – American Academy of Professional Coders – //www.aapc.com/
- AHIMA – American Health Information Management Association – //www.ahima.org/
- AAHAM – American Association of Healthcare Administrative Management – //www.aaham.org/
- HFMA – Healthcare Financial Management Association – //www.hfma.org/
- NHA – National Healthcareer Association – //www.nhanow.com/
What is CPC Certification?
The Certified Professional Coder (CPC) certification from the AAPC — formerly known as the American Academy of Professional Coders — provides a big leg up. To earn this certification, you must:
- You must take an exam covering 24 different areas, including medical terminology, diagnostic codes, coding guidelines and specific coding for more than a dozen specific fields.
- Show that you have spent two years working with CPT, ICD and HCPCS codes — or that you have had 80 hours of coding education.
- Complete 36 hours of continuing education every two years to keep up with new medical treatments and changing coding regulations.
If you have more questions or comments, contact us and we will do our best to address them.