If you’re looking for an opportunity to work in a growing segment of the healthcare industry, then a medical coding or medical billing position might be right for you.
Medical coders and billers work in focused medical billing offices, doctors’ offices, hospitals, health clinics and nursing homes to make sure Medicare and Medicaid and private insurance companies compensate medical offices promptly, bill patients correctly, and make payments in an efficient and timely manner.
Medical coders do that by transcribing patients’ visits and doctors’ treatments into universal codes that are used by health care providers and hospitals as medical records. Medical billers use those codes, a patients’ contact information, to submit claims to insurance companies, bill patients, and make sure medical offices get compensated for their service. In smaller offices, medical coders and medical billers are often the same person.
Every time a patient visits a doctor, each part of that visit is described and recorded as code. Each code matches a specific sickness, diagnosis, service, prescription, test or treatment. Medical billers use those records to submit claims to the insurance company. So, records must be filed accurately or insurers will not compensate claims.
These codes are derived from the International Classification of Diseases (ICD) and, in the U.S., from the Healthcare Common Procedure Coding Systems (HCPCS) Levels I and II, and the Electronic Medical Records (EMR).
So, medical coders must:
- Review and analyze clinical statements & patient records.
- Translate diagnosis and medical information into codes using CPT, ICD-10-CM and HCPS Level II classification systems.
- Interact with physicians and assistants to ensure codes are accurate and ready to be converted into a medical billing claim.
- Maintaining patient confidentiality and information security.
While medical billers must:
- Have a good understanding of medical terminology to be able to discuss bills with insurers and patients.
- Play a vital role as liaison between medical providers, patients and insurance companies.
- Understand the coded transcript of the patient visit, and input that information into special software.
- Audit and submit claims to insurance companies for patient procedures and treatments.
- Obtain insurance referrals and pre-authorizations for patient procedures.
- Verify insurance eligibility and benefits.
- Understand insurance guidelines, including those for HMO/PPO, Medicare and Medicaid.
- Review patient bills for accuracy and fill in any missing information.
- Check payments for accuracy.
- Research and appeal denied claims.
- Talk with insurance companies about payment discrepancies.
- Set up payment plans for patients.
- Collect delinquent accounts.
- Answer phone inquiries from patients and insurance companies.
- Use medical billing software to perform job duties.
- Update software with rate changes.
- Know Fair Debt Collection Practices.
Medical coders and billers typically spend long hours sitting in front of a computer. They can work in doctors’ offices, hospitals, clinics, or at home as company employees or independent contractors. They are also employed by insurance companies, data management and billing companies, law firms and government agencies.
The medical coders and billers work together to make sure health services are recorded accurately, and that information is passed to the insurance company. After the insurance company pays their portion, the remaining amount is billed to the patient. Any co-pays and deductibles are figured into the revised amount.
As you can see, medical coders and medical billers are critical to a health care provider’s bottom line.
Besides a fixation on accuracy and an attention to detail, those interested in the field need to have:
- Excellent communication skills. Much of the job requires telephone conversation with patients and insurance companies.
- Good customer service. Rock solid customer management requires diplomacy, compassion, and clear-headed thinking.
- Computer skills. Medical billing software, a computer and an Internet connection are common tools of the trade.
- Accounting and bookkeeping. A grasp of the basics can be helpful with billing statement reconciliation.
- Medical terminology. You have to be able to talk with patients, providers and insurance companies.
- Problem solving. Discrepancies and inconsistencies are inevitable. So is knowing how to solve them.
- Comfortable in a team setting. You have to interact with other staff members.
According to the Bureau of Labor Statistics, the median salary of a medical records and health information technicians (coders and billers) in 2019 was $42,630, with an annual average growth rate of 8%, largely due to anticipated increased demand of healthcare by a rapidly aging population. The top 10% of billers and coders made more than $71,150, the bureau noted.
A 2019 survey by the 190,000-member American Academy of Professional Coders (AAPC) showed an annual salary of $54,890, a 5.8% gain over the previous year and the highest annual gain reported since the survey was started. In addition, the medical billing and coder career ranked third on a list of Best Jobs Without a College Degree by US News and World Report 2020.
There are a variety of training options for those who want to get into medical coding and billing. Types of programs, costs, length of time required for completion can all vary, depending on the school and the credential that you seek.
To become a medical information technician, you need only a high school diploma or GED. Many community colleges and private schools offer certificate and degree programs, all of which can be attended in person or online. Appropriate associate degree coursework can include anatomy, medical terminology, healthcare reimbursement methods and classification and coding systems.
Most employers want their medical coders and billers to get some type of professional certification, such as the Registered Health Information Technician certification through the American Health Information Management Association.
The most recognized certification is the CMRS exam (Certified Medical Reimbursement Specialist), which is overseen by the CBAMBA (Certifying Board of the American Medical Billing Association). Certification requires that 85% of the 800-question exam be answered correctly.
Another alternative is the Certified Coding Associate (CCA) exam. A prerequisite for the exam is the American Health Information Management Association (AHIMA) approved program. Founded in 1928, AHIMA sets the standards for medical recording and offers a self-paced online training program that can completed in 15 months at a cost of $2,385. The association also offers 8 certifications medical records management, professional and facility coding, documentation improvement, and privacy and security. online certificate and degree programs.
Meanwhile, the American Academy of Professional Coders (AAPC) offers an online certification program that can be completed in four months at a cost of about $1,500. And the Certified Professional Biller (CPB) credential is offered by exam through the American Academy of Professional Coders (AAPC). Although not required by all employers, the credential can enhance job opportunities and salary prospects.
The average cost for an online medical billing and coding associate degree from an accredited school is about $15,000 for a two-year program. Less expensive options range from $5,000 to more expensive $25,000. Some school charge per credit hour while others charge a flat fee for the entire course.
For example, Hutchinson Community College in Hutchinson, Kansas, offers students a Healthcare Coding Specialist Certificate. The online programs consist of 45 credit hours and can be completed in three semesters.
For students looking to advance their education, most credits earned from the program are applicable to the Health Information Management Associate in Applied Science degree. Tuition is about $116 per credit hour for in-state students and around $147 per credit hour for out-of-state students, making the total cost of tuition roughly $5,220 or $6,615 for certification in the state, respectively.
A self-paced option is offered by at Florida Agricultural and Mechanical University in Tallahassee. The public university’s Office of Continuing Education offers a medical coding program and provides online accreditation. The asynchronous format enables students to complete the coursework on the own schedule.
The school recommends following a pace of three modules, each of which contain three courses apiece. Total registration for three modules is $2,000. Each should last no longer than 15 weeks. Upon finishing, students receive a Medical Coding Certificate of Completion.
They may then choose to sit from the American Health Information Management Association (AHIMA), the Certified Coding Associate (CCA), the American Academy of Professional Coders (AAPC), or the Certified Professional Coder (CPC) national certification examinations.
A part of the University System of Ohio, the University of Cincinnati is also a fully remote asynchronous program. However, it is not self-paced.
With full-time enrollment, students can earn the certificate in as little as 12 months. When they finish, students can sit for the CCA or CPC national certificates, or they can choose to continue to the Associate Degree Program in Health Information Systems.
Residents of Ohio can expect to pay about $6,144 per semester with full-time enrollment. Non-resident full-time students will pay around $6,324 per semester. Part-time resident students will pay about $512 per credit hour, while part-time non-residents will pay about $527 per credit hour.
The Indiana University-Purdue University Indianapolis (IUPUI) is part of the Purdue University system and the Indiana University system. It offers a remote medical coding certificate program through Indiana University’s School of Information and Computing.
The fully online program is also asynchronous and offers 28 credit hours. Upon completion, students are eligible to sit for the CCA examination.
IUPUI’s Undergraduate Certificate in Medical Coding Program has several prerequisites. Before signing up, students must complete Physiology for Health Care Management, Anatomy for Health Care Management, Computer Concept for Health Information, and Medical Terminology.
Credits earned are eligible toward a bachelor’s degree in Health Information Management. Costs vary based on residency and other factors, but residents can expect to pay about $295 per credit hour. Non-residents pay considerably more.
Finally, the University of Alaska Fairbanks (UAF) offers a top-rated, low-cost Medical Coding Occupational Endorsement program. The school charges flat rate of $2,925 for the course, for residents and non-residents.
The course consists of four classes: Computer Business Applications, Medical Terminology, Human Diseases, and Medical Coding. The classes are not self-paced. Each have assignments that must be completed by their weekly due dates.
Upon successful completion of the program, students can expect to be prepared to take and pass the AAPC or AHIMA certification examinations. UAF also offers courses in Outpatient and Inpatient Healthcare Reimbursement at a cost of $167 per credit.
