What is Medical Billing and Coding?
Even though medical billing and coding is often referred to as though it’s a single career, in reality medical billing and medical coding are two separate functions and two unique jobs. There’s a very specific task flow that includes both medical billers and medical coders.
In This Article
What is Medical Coding?
Medical coders update patient files using a universally recognized coding system (ICD-11 index) to ensure compliance with federal regulations and insurance requirements. They first decipher a doctor, nurse, surgeon, technician, or nurse practitioner’s notes and determine which procedure and diagnosis code best reflect the treatment and services provided by the medical team.
Coders often must confer with the physician or medical team to clarify diagnosis and procedures to make sure they are interpreting the patient’s chart correctly.
What is Medical Billing?
Medical billing is a subspecialty of medical coding. Although there are programs that offer medical billing training by itself, a program that combines both billing and coding in one will be more complete, since medical coding is the first step in the medical billing process.
Medical billers take the assigned codes and the patient’s insurance information and enter them into the hospital or medical facility’s billing software and then submit these to the insurance company for payment. Medical billers will often have contact with both patient and insurance company after this data is entered. Billers also explain any charges or insurance issues, such as co-pays, to the patient.
Both of these jobs work together to make sure claims are processed accurately and thoroughly and that the medical facility or physician is paid for rendered services in a timely fashion.
Most medical billers and coders entering the profession hold a two-year associate’s degree. Because this career path is in high demand, you’ll find a variety of schools offering medical billing and coding degree options, including diploma, certificate, associate’s and bachelor’s degrees.
When deciding which one is right for you, you should consider several different factors that could influence your choice including family obligations and future career plans. If you are interested in management positions, earning a bachelor’s degree in health information management or a related subject will help.
You’ll want to consider the different facets of each type of degree program. For example, a certificate program will allow you to enter the workforce quicker, but you may earn a higher salary with an associate’s or bachelor’s degree.
It’s important to choose a well-rounded medical billing and coding training program at a quality school. In addition to academic knowledge, however, you’ll also need plenty of real-world practice. So you should also look for a program that allows you to complete an externship in a hospital, doctor’s office or other medical setting. This hands-on learning experience will be invaluable as you start your career.
As a medical billing and coding specialist, you’ll need expertise in a wide range of areas—from anatomy and physiology to insurance claim procedures and medical office administration—in order to do your job. With this in mind, a typical medical billing and coding program will include the following classes:
Anatomy and Physiology: Anatomy and physiology will give you a basic understanding of the human body’s organ systems, their functions and how they work together.
Insurance Claim Procedures: All medical billing and coding courses will offer a version of this class, which will train you in the standard procedures for filing an insurance claim.
Medical Coding: Typical coding workshops in a medical billing and coding course will teach you how to apply Current Procedural Technology (CPT), International Classification of Diseases (ICD-10) and Healthcare Common Procedure Coding System (HCPCS) codes.
Medical Office Administration: Provides basic knowledge of how to keep a medical office running smoothly. You will learn how to take care of routine tasks such as greeting patients, scheduling appointments and handling other various clerical work.
Medical Office Technology: Included with most medical billing and coding courses, this class will teach you how to use typical medical office equipment and software.
Medical Terminology: This course will train you in the proper names for human anatomy, bodily processes, diseases and related medical procedures.
Getting Your Medical Billing & Coding Education Online
Medical billing and coding is a great degree to get online, since a lot of the coursework requires a good deal of memorization. Studying and testing at your own pace can be less intimidating for some students than being in a classroom.
Read some interesting pointers that may help you decide whether an online medical billing and coding degree is for you.
Scholarships & Financial Aid
The American Health Information Management Association Foundation of Research and Education (FORE) offers scholarships to outstanding undergrads. You may also find medical billing and coding scholarships being offered at the schools to which you apply.
Medical Billing and Coding School Accreditation
If you wish to become professionally certified (and it’s recommended that you do), be sure you’re enrolled in an accredited program.
It’s a sign that an institution ascribes to, believes in—and has met—an external set of basic criteria for its programs. In all cases, it indicates that threshold standards are adhered to in a fashion that provides a base of academic strength and operational integrity.
For an accredited medical billing school to maintain its status, they must be able to show educational quality and educational improvements.
The three agencies that specifically accredit medical billing and coding programs are:
There are also regional accrediting agencies, which will vary depending on your area. These include:
Medical billing and coding accreditation is more than just a sign that you’ll be getting a quality education from your school. It will also open doors for you in the future should you choose to continue your education. For instance, if you have your associate’s degree, and you decide to go back to school to pursue a bachelor’s degree, your credits from an accredited medical billing school will transfer to other accredited institutions. However, if your school wasn’t accredited, you may not be able to transfer all your credits to your new school.
Choosing an accredited medical billing school can save you time and tuition in the long run. Keep this in mind as you search for your medical billing and coding program.
Medical Billing and Coding Salaries
According to the U.S. Bureau of Labor Statistics’ 2019 Occupational Employment Statistics, the average annual salary for medical records and health information technicians is $46,590, with the top 10% earning more than $71,150. People in this job may also anticipate great job growth, says the BLS, with the field expecting to grow 8% through 2029, which is faster than average for all other career fields combined. Read the medical billing and coding salary article to learn more about what you can expect to make. Learn what kind of things affect your earning potential and what you can do to boost your wages.
Benefits: Work at Home
One nice perk of a medical biller or medical coder career is the ability to build a clientele and work from home or as a contractor for several medical facilities or offices. While this may sound ideal if you have kids or other obligations, there’s more to starting your at-home medical billing or coding business than installing software on your computer and letting doctors know you’re open for business. To avoid the heartache of starting a business that loses money, or being taken advantage of by medical coding software scams, here are two important articles you should read first:
Few professions offer as much flexibility and mobility as medical billing and coding. We talked about one perk for the profession above but what are some of the others you might be able to take advantage of as a medical biller or coder?
Here are just a few perks to consider:
Potential Careers and Workplaces
Medical billers and coders can consider several career routes. Either you can expand your home business and become an employer of freelance or contract coders and billers or you can go back to school to earn more education.
If this is the path you decide to take, you’ll find these types of roles could expand upon your initial education and provide advanced career options:
Roles and Workplaces
Roles and Titles
Places You Can Work
Advancing Through Certification
Getting your degree and completing your accredited program are the first steps to success as a medical biller or coder. But if you’re dedicated to moving ahead of the pack and really excelling in your chosen career, you’ll want to consider earning your certification. Certification assures employers that you have the best professional qualifications to do your job. The American Academy of Professional Coders (AAPC) offers several types of professional certifications and specialty credentials, as does the American Health Information Management Association (AHIMA).
Medical Billing and Coder Traits and Skills
Medical billers and coders, also known as medical records and health technicians, are part of a growing area of health care. This in-demand career won’t call for you to provide any patient care, but you will be interfacing with physicians and other health care professionals regularly. Here are some skills and traits you should have to excel in the field:
You should have…
- Good concentration
- Excellent communication skills
- Basic computer skills
- High ethical standards