What is medical billing and coding? It refers to the system used by medical facilities to receive reimbursement from health insurance companies. Health care providers rely on medical billers and coders to keep their records accurate and submitted in a timely manner to insurers. Graduates of medical billing and coding programs may be responsible for all the following duties:
- Reviewing patient records for completeness and accuracy.
- Maintaining data in clinical databases and registries.
- Applying clinical codes to patient procedures.
- Submitting data electronically for insurance reimbursement.
- Maintaining the confidentiality of patient records.
Medical Billing and Coding Specializations
Falling under the umbrella of medical records and health information technicians, billers and coders may wear many hats or they may specialize. Often, they fall into one of the following three categories.
- Health Information Technicians: These professionals may perform many functions within an office. They may maintain records and databases as well as track patient outcomes and compile data for storage or reporting.
- Medical Coders: Medical coders have the job most often associated with medical billing and coding schools. They may review patient information for preexisting conditions, retrieve patient records and act as liaisons between the medical provider and the billing office or insurer.
- Cancer Registrars: Cancer registrars compile and analyze cancer patient information, review patient records and pathology reports and assign the proper classification codes for diagnosis and treatment of benign tumors and cancers.
How to Become an Medical Biller and Coder
Since medical billers and coders are dealing with complex reimbursement systems, they must have some formal education after high school. Consider these steps to become a medical biller and coder:
- Earn a high school diploma or equivalent.
- Aim to complete postsecondary training -- a certificate or associate degree can help you rise above the competition.
- Gain experience working in the field.
- Consider official certification beyont postsecondary training to improve your career advancement options later on.
When in school, medical billing and coding schools often have a curriculum that teaches all the following:
- Medical terminolog
- Health data standards
- Classification and Coding Systems
- Healthcare Reimbursement Systems
Medical Billing and Coding Degree Programs
Given how much material is taught, you may be wondering how long is school for medical billing and coding. Although these programs must cover a lot of ground, they can usually be completed in two years or less. Your actual time in school will depend on which of the following two routes you take.
- Diploma/Certificate: These non-degree programs may run anywhere from a few months to one year in length. Their curriculum may include courses on medical terminology, types of health insurance and coding practice. Some even include the cost of preparing and taking the exam for medical billing and coding certification programs.
- Associate Degree: An associate degree in medical billing and coding can take two years to complete. It may provide a more in-depth review of medical billing and coding procedures as well as instruction in topics such as electronic medical records. An associate degree may be a good choice for those hoping to move into supervisory positions or who plan to one day pursue a bachelor's degree.
Schools for Medical Billing and Coding
Since much of the work of medical billers and coders is computer-based, this is a field that lends itself well to online learning. You can find a number of medical billing and coding online schools, and these may offer diplomas, certificates and degrees. In addition to textbook instruction, online medical billing and coding schools may use computer simulations to provide students with real-world experience.
Licensure and Certification for Medical Billers and Coders
While a few states may require cancer registrars be licensed, medical billers and coders don't need any government credentials to work. However, many employers prefer to hire those who have obtained a voluntary certification. Medical billing and coding schools often prepare students for these certifications as part of their curriculum.
The following are a few of the medical billing and coding certification programs available:
- Certified Professional Coder (CPC) from the AAPC
- Certified Professional Biller (CPB) from the AAPC
- Certified Billing and Coding Specialist (CBCS) from the National Healthcareer Association
- Certified Coding Associate (CCA) from The American Health Information Management Association
- Certified Coding Specialist (CCS) Certified Coding Specialist (CCS)
- Certified Medical Reimbursement Specialist (CMRS) from the American Medical Billing Association
Additionally, more than a dozen specialty coding certifications in fields such as family practice, obstetrics and gynecology and pediatrics are available from the AAPC and The Professional Association of Healthcare Coding Specialists.
Each certification program has its own criteria. Most require applicants graduate from approved medical billing and coding schools and pass an exam. Some may have work experience requirements as well.
Medical billing and coding career avancement
Medical billers and coders may advance their careers in several ways. By earning additional certifications, such as specialty designations, they may be able to move into new positions. Some professionals may advance to supervisory roles once they have experience while others choose to go back to school for a bachelor's degree. Gaining additional education could lead to a career as a medical or health services manager.
Skills and Qualities for Medical Billers and Coders
To excel in this job, you need to have certain traits and abilities. The following are a few of the skills possessed by successful billers and coders.
- Reading Comprehension: - Billers and coders may need to review notes from patient visits to understand what procedures were provided and how care should be billed to insurers.
- Critical Thinking: - Critical thinking skills come into play when medical billers and coders are presented with information that is not clear or an insurer rejects a bill. Workers need be able to determine how best to respond and resolve the issue.
- Near Vision: - Medical billers and coders do much of their work on the computer and must be able to clearly and comfortably read the screen.
- Category Flexibility: - This ability refers to how well a person can group information using sets of rules. It's an important trait for billers and coders who have decide how to group and label procedures for billing purposes.
- Information Ordering: - Similarly, medical billers and coders must follow exact systems for insurers to accept and pay bills, and information ordering is the ability to arrange things according to a set of rules.
Career Outlook and Salary Information for Medical Billers and Coders
What is medical billing and coding salary, you may ask. The chart below provides a range of incomes for professionals nationwide. However, your medical billing coding salary may vary depending on your region, education and certification. Job growth for the profession can also vary across the country. But here's a look at what is expected nationwide for the coming years:
Projected Job Growth
|Medical Records and Health Information Technicians||208,650||$44,010||10.7%|
Professional Resources for Medical Billers and Coders
From advocating for workers to offering medical billing and coding certification programs, here are a few resources that are important to the profession:
- AAPC - Previously known as the American Academy of Professional Coders, AAPC has 180,000 members and is the largest healthcare business training and credentialing organization in the world.
- American Medical Billing Association - The AMBA says it represents the gold standard in serving medical billers through certification, free webinars and other services.
- The American Health Information Management Association - Founded in 1928, AHIMA has a long history of supporting the work of health information professionals through certification, continuing education and advocacy.