Written by The medical industry is one of the fastest growing occupational fields in the country. Two of the fastest growing professions in this field are medical billing and medical coding. While they are often listed together as “medical billing and coding,” they are, in fact, separate occupations. The former is often considered to be a subspecialty of the latter. Either of these professions can provide practitioners with a decent income, a flexible lifestyle and the independence that comes with running a small business.
Medical Coding
Whenever a patient goes to see a doctor, the doctor will list his or her diagnosis and any treatments or procedures that were performed on the patient’s charts. The same thing happens whenever someone is treated at the hospital or at another healthcare provider. A medical coder then takes the chart and translates this information into the proper medical codes. Everything a doctor does in an office has a code associated with it. There is a code for blood work, for physical exams, for breathing treatments and for every other procedure that can be performed and for every service that can be rendered.
Furthermore, there are sub-codes for each type of procedure. For example, if a doctor orders blood work for a patient, there will be a code for the blood work. There will also be a sub-code that explains the purpose of the blood work; for example, a cholesterol screening test will have a different code than a test that is designed to check for cancer or an infection.
Diagnoses are also given individual codes. These codes are often divided into groups based on the type of illness and/or the region of the body that is affected by it. For example, respiratory track illnesses have their own set of codes, as do injuries.
Almost all of the codes in common usage are numerical. Some common coding systems include the ICD-9, CPT and HCPCS systems.
Medical Billing
Medical billers use medical codes to prepare reimbursement requests for insurance companies. These reimbursement requests are known as claims. Medical billers prepare these claims for medical equipment, medications, doctor’s appointments, procedures and many other healthcare services.
In addition to preparing claims, medical billers will submit them to the various insurance companies, post payments, answer any questions the insurer may have and appeal any denials. Billers will often have to interpret and/or double-check the work that has already been done by medical coders. They must also frequently seek clarification from doctors and other providers about what procedures or services have been performed.
Why Billers and Coders Are Important
The medical industry can not run properly without skilled medical coders and billers, as medical coders are responsible for translating a patient’s diagnosis into codes for his or her permanent file and medical billers are responsible for ensuring that the physician receives payment for his or her services. Doctors do not have the time to handle the enormous volume of paperwork that comes with both billing and coding.
When a patient switches physicians or is sent to see a specialist, frequently the only items that are transferred between offices are the diagnosis codes and a short summary. If the medical coder forgets to input a code or inputs the wrong code, the patient may not get the care he or she needs. This can happen even if the patient stays with the same office if his or her chart gets lost or misplaced. Doctors see a lot of patients and can not be expected to remember all of them or their various conditions.
Medical billers hold even more responsibility than coders. A claim that is submitted improperly will be rejected, and the office will have to wait on payment while another claim is submitted and processed. Furthermore, if the wrong code is used on a claim, the doctor may end up being underpaid or overpaid. Similar procedures can have wildly differing reimbursement rates; the difference may be anything from a few dollars to several thousand dollars. This is why it is so crucial that the correct codes be used and why medical billing is a specialized profession.
How to Become a Medical Biller or Medical Coder
Currently, both medical billing and medical coding are unregulated industries. This means that a person is not required to obtain a license, degree or certification in order to enter the industry. Anyone may submit an application for a medical billing or coding position.
Practically speaking, however, most medical practices are very selective about whom they hire. These positions are too critical to the success of a practice or a hospital to risk hiring someone who does not know the proper procedures and coding systems. The people who get hired tend to be those who have received at least some training and/or are certified. Several different certifications are available, including ones from the National Healthcareer Association (NHA) and the Medical Association of Billers (MAB).
Educational programs are also available. Many local community colleges and state employment offices now offer medical billing and coding programs. These programs have low fees and may be completed in as little as 18 months. A number of places also offer certification courses online. Prospective students are encouraged to check out any online provider, however, as a number of scams have cropped up in recent years.
Job Opportunities in Medical Coding and Billing
In the 2010-2011 Occupational Outlook Handbook, the Bureau of Labor Statistics states that the two fields are expected to grow by 20 percent between the years 2008 and 2018. This translates into thousands of new job openings at doctor’s offices, hospitals, medical equipment providers and other healthcare-related businesses.
Full-time coders and billers usually work in an office setting and tend to work business hours Monday through Friday. Many medical coders and billers work part time, however, and a number of professionals in both industries also work on weekends or evenings. A large number work from home.
A lot of medical coders and billers are self-employed. This means that they run their own business and contract their services out to various healthcare providers. Some of these entrepreneurs build their small businesses into larger operations and take on employees and larger contracts.
It is hard to pin down an accurate average salary for medical billers and coders because there are so many part-time, temporary and contract workers. In the year 2008, the median, or middle, salary for people working in this field was $30,610, according to the Bureau of Labor Statistics. This means that half of workers earned more than this amount and half earned less. Low earners made less than $20,440; it is probable that many of these workers were part-time coders or billers. On the other end of the scale, the highest earners made in excess of $50,060.
Earnings also vary by type of employer. The highest-earning coders and billers, on average, tend to work for the federal government, which hires numerous members of each occupation to work on the Medicare program. The lowest-paid coders and billers usually work for stand-alone medical practices. Those who work for hospitals, outpatient care centers and nursing homes tend to make salaries that fall somewhere between the two extremes. Salaries may also vary by region.