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What is Medical Billing and Coding?

What is medical billing and coding and how do I get a medical billing and coding certificate? Read on and learn more.

Prospective students often ask: What is medical billing and coding? Healthcare providers regularly need to process patient data. This includes insurance information, treatment records, and payment procedures based on your insurance information. Medical billers and coders are tasked with performing this responsibility. Also known as health claim specialists, they are responsible for coding a patient’s information and diagnosis, and requesting payments from the patient’s health insurance company based on this information.

Medical billers and coders work together to ensure that healthcare providers receive adequate and timely reimbursement for the services they render. They work within a professional office setting, obtaining information from the healthcare provider and transforming this into bills sent to the insurance provider.

Medical Billers and Coders are Specialists

So what is medical billing and coding and what do these specialists do? Medical coding specialists are usually charged with receiving patient information (diagnoses and treatments) and transcribing them into the right codes in the patient’s Electronic Health Records. This is done using a special coding system (usually using ICD-10, CPT and HCPCS Level II classifications). These specialists also have to collaborate closely with other staff to ensure accuracy of the coded information, and with the patient (if need be) to clarify insurance details.

The medical biller then proceeds to file a claim. Once a claim (basically an insurer’s invoice) is filed with the insurance company, medical billers are required to follow up with them until payment is made. They work to ensure that this payment is made on time and as required, in order for the healthcare provider to receive sufficient reimbursement for their services. As the field continues to advance, medical billers and coders are to keep informed of latest best practices to enable them to perform their job efficiently.

Medical Billers and Coders: Where are they needed?

Medical billers and coders can work in a variety of settings within the healthcare community. Given the roles they perform, their services could be needed in the offices of private practice physicians, within hospitals, emergency rooms, ambulatory centers, and insurance companies. The exact duties of a medical biller will typically vary depending on where they work, but their general duties will remain within the realm discussed in this post.

Medical Billing and Coding Optimizes Healthcare Provision

What is medical billing and coding in terms of optimizing healthcare? Medical offices are heavily dependent on the reimbursements they receive from insurance companies to keep their income flowing. However, with little knowledge of the insurance process, it is not very uncommon that potential reimbursements go unpaid, even as patient needs continue to soar. Medical billers ensure that medical facilities can rest easy knowing they will be efficiently reimbursed for their services.

With a clear understanding of medical insurance, claims filing and follow up, and the appeal process, medical billers are equipped to take on the rigors associated with dealing with insurance companies. They thus optimize the performance of healthcare providers by ensuring the safety of their revenue.

What is medical coding? Medical coding is a preferable and appropriate method for simplifying and efficiently handling the vast array of paperwork inside the medical field.

The medical field includes a vast array of diagnoses and treatments. The field also includes several processes for various kinds of treatments, resources and diagnoses for several types of injuries and diseases. Diagnosis is the first step for a doctor’s treatment plan before they follow proper procedures to the diagnosed disorder.

The variety for each result is so huge that is very difficult and complicated to present every medical scenario effectively within the tremendous amount of paper work and/or electronic documentation that goes into seeing thousands of patients every day.

The solution to reduce complexity? Medical coding. Anyone inside the medical coding profession will tell you how important and meaningful their job is to any hospital, clinic or doctor’s office, anywhere. Keep reading to gain the answers to the question what is medical coding?

What is Medical Coding? A Definition and History

Many students ask: “what is medical coding?” Medical coding is the process which includes transformation of results associated with medical procedures and services into universal medical code numbers.  The results vary from prescriptions to radiological results. Nowadays, with improvements in technology, medical coding is widely used and performs well in the digital age. With today’s technology, medical codes can document the entire history of a patient’s encounter with that particular physician who is treating him/her. These codes must be as specific as possible for the purpose of capturing financial reimbursement for delivered medical services.

To understand these medical codes, a medical coder is a certified professional who receives training in the various code books available for different types of procedures. The first medical coding system, designed by the French physician and statistician Jacques Bertillon, originated in the late 1800s. This system was also known as Bertillon Classification of Causes of Death. The system was primarily used for classification and tracking of mortality.

Fast forward to the present day, The American Association of Pharmaceutical Scientists (AAPS) is a healthcare association which deals with the use of medical coding and provides certification and trains medical students on how to use medical coding. The American Academy of Professional Coders (AAPC) is another well-known group that provides medical coding certification. Additionally, the American Health Information Management Association (AHIMA) also provides certification options. These organizations do a fine job working with the next generation of medical coders to shape the industry for the future.

Medical Billing and Coding as a Profession

The medical coder and medical biller can be the same person for a single company or different people serving several organizations to help enhance the transparency of payments and efficacy of payment processing. To promote effective coding and billing procedures, the coder checks the patient’s medical record to verify the job was done well. Medical coders must have excellent intuition and intelligence. They should pick up on things very quickly as there are many adjustments and changes throughout the medical profession. In order to become a medical coder, the right education from an accredited college or university is important, in addition to a credible third-party certification.

Medical Coding Classifications

In the world of medical coding, there are typically four classifications of medical codes. Depending on the industry and specialty you work in, the codes can change greatly. These codes are universal across all offices, hospitals and clinics.

Diagnostic codes

  • Used for determining diseases, disorders, and symptoms
  • Can be used for measuring morbidity and mortality
  • Examples: ICD-9-CM, ICD-10

Procedural codes

  • These codes include numbers or alphanumeric codes to identify specific medical processes taken by medical authorities
  • Examples: ICPM, ICHI

Pharmaceutical codes

  • These are codes used for identification of medications
  • Examples: ATC, NDC

Topographical codes

  • These include codes that give specific locations within the human body
  • Examples: ICD-O, SNOMED

Medical Coder Salaries

Before you even begin considering the requirements needed to become a medical coder and the best certification option for you, one of your major concerns might hover around your potential salary earnings. How much can you possibly earn as a medical coder?

To be fair, your potential salary earnings will be dependent on a number of factors.

Factors That Affect Medical Coding Salaries

  • Credentials: According to the AAPC salary survey, average medical coding salaries differed quite significantly for 16 different primary coding credentials. While the CPC-A credential received an average annual salary of $32,792, making it the lowest possible average, the highest average belonged to the CPC-1 with an average of $50,543.
  • Highest Education: Statistically, those with higher degrees commanded generally higher salaries than other coders. While high school coders with a coding certification could earn around $39,000 on average, non-certified coders with a doctorate degree earn on average $62,500.
  • Experience: An obvious factor affecting any salary structure is years of experience. Certified coders with up to 25 years of experience could earn as much as $20,000 above certified coders with no or only one year of experience. Indeed, salaries could increase by as much as $500 to $3,500 for every additional year of experience.
  • Work Environment and Job Description: Coders working in hospitals and large medical facilities tend to earn more on average than their counterparts in long term care facilities or home health facilities. Likewise, coders employed as ‘consultants’ ranked as the highest paid medical coders – above those employed with titles like ‘educator’, ‘product development’, ‘manager’, etc.
  • Location: Broken down by region, it was found that some regions consistently paid higher salaries to medical coders on average than others. Using the US government’s Census Bureau breakdown, the Pacific sub-region ranked highest with the East South Central sub-region ranking lowest on the list of average medical coder salaries.

Average Medical Coding Salary

In general, the average medical coder is estimated to earn about $17 per hour. However, the AAPC’s survey places the average medical coder (regardless of skill, location, credentials, etc.) to earn approximately $52,000 annually. This drops to an average of $45,035 for professionals with no certification, and $51,477 on average for certified medical coders with at least one certification.

Regardless, a medical coder’s salary potential will depend on a variety of factors. With experience, education, credentials, location, specialization, and job description all playing a major role in determining your eventual wages.

Medical Coding Serves A Critical Need

Currently, medical coding is an excellent profession that is sought after by medical offices, clinics and hospitals around the globe. Overall, medical coding is a very useful and growing profession that represents a critical need by healthcare organizations. Medical professionals are continuing to turn towards the medical coder as a force in the industry. The quantity and quality of certified coders will continue to be a key component inside the medical profession for decades to come. Medical coding is considered the safe and best way to handle important medical records.

Medical Billing: Overview

Medical billing is an essential part of any clinic, doctors office or hospital. If you want to know, what is medical billing? This post has your answers!

Healthcare providers consistently render services included in your insurance coverage. When this is done, there arises a need to follow up on these claims with your health insurance provider to enable them receive payment for these services. This is where medical billing serves a purpose. The medical biller within the healthcare facility translates the rendered service into a claim filed with the insurance company, and follows up on the claim to see to it that the healthcare provider is reimbursed.

All healthcare providers such as nurses, doctors, dentists, etc. submit claims with insurance companies following the administering of any services, whether these are simple examinations or complex treatments. Although previously handled manually on paper, medical billing is now done using a medical billing software, allowing healthcare providers to submit and manage claims more efficiently in an electronic format. This ensures the speed and efficiency of payment processing and better reimbursement.

Why is Medical Billing Needed?

Your trip to the doctor does more than simply initiate a relationship between you and the doctor. As an insured patient, you begin a three-way interaction between you, your healthcare provider, and the insurance company; although some of this interaction happens behind the scenes. As the patient, you play the role of the first party in the interaction, while your healthcare provider of choice (physicians, hospitals, hospices, and the like) is the second party, and the insurance company is the third party.

The role of the medical biller involves sending a bill (invoice) to your insurer (who will be making the payment on your behalf) detailing your personal information, medical history, insurance provision, and all of the health services you have received from the healthcare provider. The invoice sent is called a claim. The biller’s job is to ensure that adequate payment is received for the services of your provider.

What is Medical Billing Nurse

What is Medical Billing: Bridging the Gap

Depending on your insurance coverage, your insurance provider may be obliged to pay all of the bill, or they may have to co-pay a part of it. However, insurance companies are notorious for their desire to lower claims as much as they possibly can, or skip paying claims altogether. Should this become a consistent practice, hospitals could run into severe losses. Medical bills have increased significantly over the years to make up for any losses, but healthcare providers have gone a step further.

Professional medical billers are hired to ensure that claims are filed properly and that the provider receives payment for the service rendered. These professionals serve as a bridge between both parties, requesting and receiving adequate information from physicians and other healthcare professionals concerning your diagnoses, treatment, and the like. This information is then put together so that claims can be filed properly. The bill you eventually receive following your procedure is prepared by the biller after every deductible (including your insurance coverage) is factored into the original cost.

Indeed, the skilled medical biller ensures that your favored healthcare provider remains financially healthy. They also ensure you do not have to make payments for items covered by your health insurance package.

Medical Biller Salaries

Medical billers have continued to enjoy an increase in potential salary as the need for professionals in this field continues to rise rapidly. Medical billing professionals – like their coding counterparts – will see their overall potential earnings, though, affected by a number of factors. Generally, medical billers can positively influence their salaries through training, certifications, and experience. Likewise, the decision to specialize as a medical biller can greatly improve your earning potential.

Factors Affecting Medical Billing Salaries

Salaries of medical billing professionals are influenced by individual performance, as well as other factors such as skill level and job responsibilities. Other important factors include:

  • Location: The states of New Jersey, District of Columbia, Hawaii, California, and Colorado were ranked by Medical Billing School as the highest paying states for medical billing professionals. Billers in these states earn an annual average salary of $55,130, $45,500, $42,500, $42,270, and $42,110 respectively. Among the 5 states that employ the most medical billers, the state of California ranks as the highest paying.
  • Industry: Medical billing salaries vary greatly by industry of employment. Industries that employ lots of medical billers seem to rank fairly lower on the scale of high paying industries than low employing industries, thanks to the impact of demand. Particularly, according to the US Bureau of Labor Statistics, billers and coders in the Pharmaceutical and Medicine Manufacturing industries earn an annual average salary of $66,060. A figure which drops to $46,280 for billers working with the Federal Executive Branch.
  • Experience: An entry level medical biller can be started on a salary between $33,585 and $39,066 annually, according to Mid-career, this figure increases to between $26,944 and $44,649; which again increases significantly to between $28,474 and $48,729 for experienced billers.

What do Medical Billers Earn on Average?

As earlier noted, the average annual earnings of a medical billing professional is dependent on quite a number of factors. Classified alongside medical coders as Medical Records and Health Information Technicians by the US Bureau of Labor Statistics, they are estimated to earn an average annual salary of $42,820 as of 2017. This translates to an average hourly wage of $20.59. These figures indicate a continuously upward trend after hitting the $36,000 mark for annual earnings back in 2011., a website that specializes in reporting professional earnings, places the medical billing salary between $25,000 and $44,000 per year. With such a wide gap between top and bottom, it becomes clear that a number of factors could swing an individual’s salary either way, as noted above. It is also important to note that while a medical biller might sometimes be tasked with the duties of a medical coder, when these tasks are separated, coders earn marginally more than billers due to the need for specialized knowledge.

Medical Billing and Coding: Top 5 Skills

Working largely behind the scenes, medical billing and coding specialists serve as a link between physicians who care for patients and health insurance companies who cover their services. Taking a program in medical coding or billing, or obtaining certifications from specialist bodies, will equip you with the relevant skill for a career path as medical coder.

Advancements in medical technology and the adoption of electronic health records and databases ensure that medical billers and coders have bright employment opportunities. However, with the crucial role played by medical coders and billers in the healthcare sector, there is a need for soft personal skills that go beyond your certifications if you are to become a successful specialist.

What is Medical Billing and Coding - Top 5 SkillsSkills Needed for Medical Billing and Coding

If you want to succeed in the medical billing and coding career field, here’s our pick for the top 5 skills needed for medical billing and coding:

  1. Deep Knowledge of Medical Science and Terminology

Medical coding goes beyond simple clerical jobs, with medical coders expected to have a deep and clear knowledge of human anatomy and physiology – as is the case with other healthcare practitioners. Medical terms can be confusing if you do not know them well enough, and errors in coding could cause delays in payment and other challenges. Thus, coders are required to master complex clinical language to properly execute their job.

  1. Thoroughness

One of the foremost traits required of a medical coding and billing specialist is thoroughness or attention to detail. Medical coders must be clearly aware of the distinctions between every alphanumeric code in the ICD-10 medical coding system. This thoroughness is especially important as medical coders will likely be juggling through different documents as they work. You must be able to carefully identify the required code as you examine appointment, exam or surgery reports in order not to delay or jeopardize the healthcare process.

  1. Analytical Thinking

An analytic mind is required if you are to carefully understand medical diagnoses and convert same into proper medical codes. Patient information and reports are not always straightforward, sometimes requiring you to study them critically before ascertaining the appropriate code. This is important as you do not want to overbill the patient or delay the reimbursement of your employer.

  1. Discretion and Integrity

Medical billing and coding specialists deal directly with sensitive patient information. A strong moral code and high level of integrity are required from medical coders who are expected to understand and respect patient’s right to privacy. All medical information of each patient must be treated anonymously and with strict confidentiality.

  1. Technology-oriented

Medical billing and coding specialists have enjoyed increased demand over the past few years mostly due to the shift to computerized medical data storage and processing. The use of Electronic Health Records (EHR) software for patient record storage, as well as billing and insurance claims is now a given with most healthcare providers. Although you will be trained to use this software, you should be tech savvy enough to adapt to changes in this technology, and to deal with new software programs you might not come across during your training.

Top 5 Medical Billing and Coding Employers

Medical billing and coding jobs are continuously increasing in demand. As the demand for these jobs increases, so too does the pay associated with them and the possibility for career advancement. Skilled medical billers and coders will benefit from the job settings available to them, including hospitals, retirement homes, medical offices, health insurance firms, and government offices.

Like every specialized job, job security and stability are important concerns. However, medical billing and coding jobs continue to rise in demand, with the flexibility that allows you work in different organizations or even from home. Consider some of the top cities in demand for medical coders and billers, and some of the best employers below.

Top Medical Coding and Billing In-demand States (US)

Medical billing and coding professionals in the US will benefit from the healthcare sector reform that has seen their career become increasingly more important. While the demand for this profession continues to rise in the United States, the US states and cities that have recorded the most demand for these professionals include:

  • Texas
  • Arizona
  • New York
  • New Jersey
  • Florida
  • California
  • Arkansas

Within these states, such cities as Dallas, Houston, New York, San Antonio, and Los Angeles have enjoyed a steady increase in demand for medical billing and coding specialists.

Top Medical Billing and Coding Employers

  • Parexel International Corporation: With over 18,600 workers in its employ worldwide, Parexel continues to employ state of the art medical technologies in its processes – winning the Gold Stevie Award as recently as 2015. Medical billing specialists and clinical data analysts rank among their more desired employees of recent with a salary well above the national average. However, BSc and AAPC certifications are both required.
  • Global Revenue Cycle Partners: With its headquarters in Wilmington, Delaware, this global multinational healthcare partners have about 1,000 healthcare employees on their books. Medical coders with no less than 6 months experience are sought after in the US and abroad, with preference currently given to those specializing in emergency medicine or radiology.
  • Maxim Health Information Services: One of the America’s largest medical staffing companies, Maxim Health Information Services employs remote medical coders with ICD-10 training. Despite working remotely, these employees enjoy full employment benefits, including 401(k) and dental. There’s also room for progress into positions as a medical coding supervisor.
  • Humana: With over 13.8 million medical members, it is no surprise that Humana features on the Fortune 500 list. Medical coders and billers with CPC or CCS-P certifications are currently sought after, with many of these remote positions or telecommuters.
  • Precyse Solutions: A clinical data management firm with over 4,000 healthcare partners, Precyse solutions boasts a team of almost 400 certified medical coders in 41 different states. AHIMA credentials are a must for applicant positions, with 2 years of working experience a requirement.

Bryan University has a degree program that can help you achieve greatness and develop those top skills needed as a medical billing and coding specialist.

If you are not a student, but are thinking of a career in medical billing and coding, what are you waiting for? Contact us and set up a time to speak with one of our admissions representatives. Or, check out our medical billing and coding program options at Bryan University:

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