Medical billing is the process by which a doctor or hospital receives payment for their services. Medical coding is one step of the medical billing process, during which the treatment is assigned a special code used by insurance companies to process a claim. While medical billing and medical coding are technically two different jobs, they are often done by the same person. That’s why training programs often group these skills under a single program titled “Medical Billing and Coding” or “Health Information Technician.”
Medical coding is a surprisingly complicated procedure. It requires broad medical knowledge that encompasses various forms of treatment, diseases and thousands of different medical codes. Insurance companies use these codes in their investigations and the payment of any associated costs. As per the American Academy of Professional Coders (AAPC), medical coders need to be familiar with different types of insurance plans, regulations, compliance, and the coding community’s three critical resource books: CPT®, HCPCS Level II and ICD-9-CM along with their corresponding codes and guidelines.
The job of the medical billing specialist is also an important one. When a person receives any treatment, the physician, clinic or hospital responsible needs to get paid. The medical biller collects the relevant information, produces a bill and forwards it to the appropriate person or organization. They are also responsible for maintaining billing records and following up on any queries.
Typical steps of the medical billing process include:
- The medical biller inputs all pertinent patient information into a database.
- The medical coder assigns an appropriate code for the procedure based on the classification system used by insurance carriers.
- Once a specific code has been assigned by the medical coder, an insurance claim form can then be completed by the medical biller and submitted to the insurance provider.
- The claim form is then reviewed by a claim’s processor and either approved or denied.
- If the insurance claim is approved, the insurance company will reimburse the healthcare provider as per the rates set for the specific code that has been assigned.
- If the claim has been denied by the insurance company, the medical biller must determine the reason why and notify the health care practitioner. The medical biller then creates an invoice for the patient.
- Medical billers may also be responsible for collection of unpaid bills and working with insurance carriers to investigate cases of possible fraud.
The largest employers of medical billing and coding professionals are hospitals. However, there are also opportunities to work for private physicians, health insurance companies, medical billing companies, outpatient health clinics, nursing care facilities, home health agencies, pharmacies, as well as work from home.
Learn more about what to consider when choosing your career in medical billing & coding.
Educational and Training Requirements
As per the AAPC, there are no mandated education requirements to become a medical biller or coder in Florida. However, the AAPC does advise that there is a specific foundation of knowledge and skill set that can best obtained only by enrollment in an accredited training program. Employers also prefer to hire those who have attended formal training at an accredited program since this attests not only to a candidate’s knowledge of the field, but also to their commitment to this career. This is particularly important for medical coding, because a medical coder must have deep knowledge of thousands of medical terms and insurance codes, which takes time and effort to learn.
Accredited programs are offered in both community and four-year colleges. Obtaining an associate’s degree in Medical Billing and Coding will provide you with a competitive advantage in seeking employment over those candidates with a high school diploma or general equivalency diploma (GED). An associate’s degree will also enable you to start at a somewhat higher salary. These programs are designed to provide a broader education and are a good choice for those interested in continuing their education as credits will count fully towards a bachelor’s degree. A typical associate’s degree in this field will take 1 to 2 years to complete and cost up to $20,000.
A bachelor’s degree in the field of Medical Billing and Coding will give you the opportunity to enter the field at a higher level, such as management or administration positions. In these positions you will be responsible for supervising the work of medical billers and coders.
Certificate programs are tailored toward people who already have either an associate’s or bachelor’s degree in another field and are undergoing a career change. The length of study will vary from three months to one year depending on whether you participate in the program on a full or part time basis. The cost of obtaining your certificate is about $3,000.
Coursework in each of the above-mentioned programs will include anatomy and physiology, medical terminology, clinical pharmacology, CPT coding classification systems and software, medical office management, and insurance claim processing. Most programs will also include a practicum experience that provides students the opportunity to gain “real-world” experience as a medical biller and coder within a hospital setting or private physician office.
The American Health Information Management Association (AHIMA) accredits programs in medical billing and coding.
Both the American Medical Billers Association (AMBA), and the AAPC offer courses for students interested in taking medical billing and coding certification exams. The courses are shorter and cost less, however they do not typically count for college credit. If you plan on continuing your education you should consider completing your training at a school rather than a professional association.
As per the AAPC, there are no mandatory certification requirements to begin a career as a Medical Biller and Coder. However, the credentials that come with certification are the gold standard in medical coding and billing. They are nationally recognized by employers, medical societies and government organizations. Additionally, a 2005 survey conducted by AHIMA showed that over 73% of employers nationwide perceive certification of medical billers and coders as highly valuable in terms of obtaining employment and advancing the professionalism of the field.
Certification as a medical biller or coder may be obtained from either American Health Information Management Association (AHIMA), American Academy of Professional Coders (AAPC), or the American Medical Billing Association (AMBA). AHIMA grants the Certified Coding Specialist (CCS) credential, AAPC awards the Certified Professional Coder (CPC) and Certified Professional Biller (CPB) credentials, and AMBA awards the Certified Medical Reimbursement Specialist (CMRS) credential. The coding exams offered by AHIMA and AAPC consist of 150 multiple choice questions. The CPB exam consists of 200 questions and the CMRS exam consists of over 800 questions.
Those who are new to the field with less than two years experience will be granted the designation CPC-A (Apprentice) by the AAPC. To obtain full certification as a CPC, you will need to have over two years work experience as a medical biller and coder, submit two letters of reference from employers or one letter of recommendation which verifies that you have satisfactorily completed 80 hours of continuing education over the two years.
The cost of certification for the CPC and CCS credentials is $300. To recertify your CPC credential you must complete 36 continuing education units (CEUs) every 2 years and pay the recertification fee of $125. Recertification of your CCS credential requires 30 CEUs, an annual self assessment and payment of the $50 recertification fee. In order to take the CMRS exam you must be a member of the American Medical Billing Association. Membership dues are $99 annually.
Read about the different options for financial aid.
For more details about AAPC certification, visit http://www.aapc.com/certification/cpc.aspx.
Salaries of Medical Billers and Coders
The table below provides the median salaries for Medical Billers and Coders in select major cities in Florida.
|Medical Biller||Medical Coder|
As per the Bureau of Labor Statistics (BLS), employment prospects for Medical Billers and Coders are excellent with an anticipated growth rate of about 20 percent through 2018. There are two primary factors responsible for this rate of growth: the aging of the population with the increased demand for health care, along with an expansion of medical testing across all demographic groups leading to earlier detection and treatment of disease and illness.
Healthcare organizations are one of the largest employers of medical billing and coding specialists in the country. The need for medical attention is increasing and consequently physicians and hospitals are realizing the need for a greater number of skilled front-office staff – medical billing and coding professionals in particular.
Once you have completed your training look to the AAPC, AHIMA, and AMBA websites. All are excellent sources for information that will help you move forward. Here you will find links to job listings, conferences and events, continuing education, along with various publications and other resources.