Medical Billing and Coding – An Overview
Medical billing and coding is essentially the process of submitting claims to insurance companies to obtain reimbursment for services rendered to patients by healthcare providers. But to answer the question – what is medical billing and coding – it helps to examine the dual roles that this position can incorporate.
Medical Billing and Coding – Medical Coders
So what is medical billing and coding and what do medical coders do? An entry level coder will analyze a patient’s records, which includes detailed information on the nature of their illness, their examination, existing medication, diagnosis and recommendations for treatment in order to itemize and alphanumerically code both the diagnosis and the services that a patient received during their visit to the doctor’s office or hospital. The level of service (which is determined by qualified health professionals), is translated by the coder into a standardized five digit procedure code taken from the current medical billing and coding Procedural Terminology database. The verbal diagnosis for the patient is also translated into a numerical code (currently the ICD-9-CM index, to be replaced by ICD-10-CM on 10 January 2013). The use of the universally recognized codes is to ensure compliance with federal regulations.
The code system is in place both to enable health practitioners to undertake internal data monitoring, and is utilised by medical billers to obtain the appropriate reimbursment for the health care providers from insurance companies.
Medical Billing and Coding – Medical Billers
A medical biller is responsible for processing medical billing for patient records in accordance with the relevant diagnosis and procedure codes, and submitting claims to insurance companies to reimburse the cost and/or bill the patient. In the event of a claim being denied, medical billers can facilitate an amended claim or appeal, and also assess whether patients have the financial capacity to meet any shortfall between billed and approved reimbursment amounts. Medical billers also handle:
- payments,
- co-payments,
- claims and appeals, and
- invoicing for present and past due bills.
When comparing medical billing and coding, think of a medical biller as the liaison between the doctor, insurance company, and patient.
Medical Billing and Coding – Education Requirements
Because of the complexity of a medical coder and/or biller’s job, an accredited educational qualification in medical billing or coding must be obtained before commencing your career. What is medical billing and coding education? Typically, you can get qualified either online, or at a university. Many schools offer certificates, which can be earned in a year or less, and medical billing and coding certifications as part of an associate’s degree program.
When selecting from any medical billing and coding schools, your first criteria should be that the program is accredited by either the American Health Information Management Association (AHIMA) or the Commission on Accreditation of Allied Health Education Programs (CAAHEP). If you can’t find one of those, you can also get by with one of the several regional accreditations that are offered nationwide.
What is Medical Billing and Coding – Career Expectations
So what is medical billing and coding like as a career prospect? As of the most recent reports, medical billers and coders can expect to make between $10-$15 per hour and between $30,000 and $50,000 per year on average. Obviously this is largely dependent on where you work, what type of education you have, and how long you’ve been working in the medical field.
Many people find that medical billing and coding is a great entry into the medical field, and work in the industry while they pursue a more advanced education.
Where to Start
To get started on the path as a medical biller and coder, you should first determine whether you can attend classes in person, or need them online. To assist, we’ve provided a form below to help you select available campuses in your area or online courses.
When people ask what is medical billing and coding, they’re usually on the right track to a promising start in the medical field.
Back to Medical Billing and Coding.
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