The health care industry is one of the most complex working systems in the U.S. Health care is highly regulated by federal and state governments. Nearly every action that takes place within the healthcare system is linked to an established process or procedure. Health care is also linked intrinsically to the insurance industry, which has its own set of stringent protocols and procedures. If a process breaks down at any point, it can lead to someone not receiving the medical treatment they need.
Medical Billing and Coding Careers
Medical billing and coding professionals play a key role in the health care system. These people are responsible for accurately detailing any medical services provided to a patient, the purpose being to provide the information required to process a reimbursement claim for the appropriate medical insurance provider. Without accurate billing and coding, the system that supports patients, physicians and insurance providers can break down completely.
What do medical billing coders do?
Medical coders classify and maintain records of medical procedures for use in calculating insurance reimbursement for various procedures. In some work environments the billing and coding functions are split between different personnel, but it is not uncommon to find the same person performing both tasks.
In most cases, med billing coders refer to a specialized type of software to determine the amount for which medical care providers can be reimbursed by certain insurance programs. These amounts vary depending on the type of insurance program that covers the patient, as well as the type of procedure performed.
Medical coders use numerous parameters when coding records. Here are a few of them, and a brief explanation of each:
- International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM): The standard method of assigning codes to procedures and diagnoses in the United States
- Current Procedural Terminology (CPT): This code system describes the type and nature of medical procedures performed at care facilities
- Healthcare Common Procedure Coding System (HCPCS): Based on CPT codes, the HCPCS is used by Medicare and maintained by the Centers for Medicare and Medicaid Services
The duties of a billing coder go a few steps beyond simply knowing how to access the proper code system. Professionals who become medical billing coders also take on responsibilities such as ensuring the accuracy and confidentiality of medical records, carefully entering data into computers, processing forms and developing and maintaining indexes of vital medical information.
What training is needed for medical billing and coding?
To become a billing coder, candidates need to have a high school diploma or equivalency, and then complete a post-secondary certificate program or associate's degree program in medical billing and coding. This type of education can be typically found at a large range of technical schools and community colleges. Associate degree programs in this field generally take one or two years to complete. Some colleges offer their associate degree programs online as well as on campus.
The American Academy of Professional Coders (AAPC) is the nation's largest professional training and accreditation organization for medical billing and coding. AAPC offers both traditional classroom courses as well as full online distance learning versions of its curriculum. Other organizations offering certifications for medical billing and coding are the American Health Information Management Association, and the Professional Association of Healthcare Coding Specialists.
As with the industry itself, some schools split billing and coding components into two different programs, something candidates should watch out for when looking at training options.
Candidates looking to take medical billing and coding training can expect to encounter the following subjects:
- Medical terminology
- Human anatomy and physiology
- Advanced computing technology and usage
- Medical transcription and voice recognition software
- Medical coding systems (ICD-9-CM, CPT/HSCPCS, RBRVS, DRG)
- Basic pharmacology
What is the job outlook for medical billing and coding?
As the population ages, the demand for health services is expected to grow significantly. The U.S. Bureau of Labor Statistics (BLS), which classifies medical billing and coding employees as "Medical Records and Health Information Technicians" has some positive information concerning the demand for people in this field.
What is the salary for medical billing and coding?
The BLS reported that there were over 186,000 jobs in the "Medical Records and Health Information Technicians" industry as of 2012. The BLS also has some detailed information concerning salary numbers for these professionals.
"29-2071 Medical Records and Health Information Technicians," U.S. Bureau of Labor Statistics Online Education Statistics, May 2014, http://www.bls.gov/oes/current/oes292071.htm
"Medical Records and Health Information Technicians," U.S. Bureau of Labor Statistics Occupational Outlook Handbook, January 8, 2014, http://www.bls.gov/ooh/healthcare/medical-records-and-health-information-technicians.htm