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What is Medical Coding and Billing? The Truth behind the Job

As technology is on the rise, many jobs are being fully based on it and more and more people are thinking about choosing a career that implies working on a computer, or even working from home.

The benefits of entering the healthcare system are also on the list of people who want to make a career and are interested in helping the system and the doctors. Medical billing and coding are two of the most important components in any medical practice. Accuracy in both areas is vital to patient safety and correct and efficient payment. Both medical billing and medical coding require professionals who can interpret and track medical information and maintain patient confidentiality. Medical billers, as well as medical coders are important pieces to the medical system. These specialists perform tasks that keep the healthcare industry on the correct path, actually reducing the volume of information, from hundreds of actions and prescriptions to codes.

Many sources say it is indeed a very good time to look at a career in medical billing and coding. The health care system is modernizing just as a large portion of the population is retiring and the demand for professionals who can process important data is growing accordingly.

What does medical coding mean?

This career divides into two roles. Medical billing and medical coding. Medical coders need to assign medical codes for injuries, illnesses, diagnoses and receipts, information that is in every patient’s medical record. For each of these elements of the charts, the coder has to assign the universal medical alphanumeric codes. These codes are actually the universal language that is used between doctors, hospitals and insurance companies.

Many people probably ask themselves why we need to transform every illness, or injury into a code. The answer is simple. The amount of data that every visit to a doctor implies is considerably growing on a daily basis. As everything needs to be recorded, the volume of injuries, illnesses and procedures, the most practical way of doing it is to transform every single action into a code and register it into software along with every patient’s medical history. This way, data is prevented from being lost and everything remains registered on a platform, so it can be accessed whenever needed.

What does it take to become a professional medical coder?

Becoming a medical coder means being accurate, reviewing the data in detail in order to find the code to use for the insurance company. The medical coders are also required to possess knowledge in technology, due to the fact that they need to submit information and data into the software and manage bills.

As technology rapidly evolves, despite the fact that medical coding and billing was done entirely on paper, many companies have developed software specifically for this area of work.

What does medical billing mean?

Medical billers process the information and the codes that are taken from the medical coder and create a claim for the insurance companies, which is also known as a bill. For example if a patient has a fever, schedules an appointment to the doctor’s office and the medical coding and billing process begins. The medical coder issues codes for every action, such as symptoms, diagnosis and prescriptions. The medical biller then takes the codes, which show what symptoms the patient shows, what the diagnosis is and what the doctor prescribes, and makes a claim using the billing software. The medical biller forwards this bill to the insurance company and the insurance company processes it. After processing it, the insurance company returns the claim, in order for the medical biller to calculate the percentage of the cost the insurance company covers. The medical biller is the link between patients, hospitals and their insurance companies. Both the medical coder and the medical biller are often compared to translators. The coder translates medical procedures translates codes into financial reports for the insurance companies. The medical billing job starts where the medical coding job stops.

Going to the doctor is actually a complex action, which requires much information and more people than the doctor and the patient. It is said that this action is a "four-party system” besides the patient - the doctor, the medical coder, the medical biller and the insurance company. It can be compared to a square, where the patient comes in on an appointment to the doctor’s office, the doctor puts a diagnosis, the diagnosis is transformed by the coder in alphanumeric characters, and the biller takes the code, processes it and sends it to the insurance company. The insurance then sends back the information about the costs and the biller processes it again. It is also the biller’s job to make sure the healthcare provider is reimbursed for their services accordingly. Furthermore, the roles of medical coders and billers, while complementary, are different.

Certifications

It is not required that you become a certified medical coder. There are employers who actually prefer job candidates with accreditation from the American Association of Professional Coders or the American Health Information Management Association. The people who have a medical coding certification can increase their salary and improve their chances for advancement in the career. The certification covers diagnostic and procedure codes for specific fields, coding guidelines and medical terminology. Once you have the certificate and you have a few years of experience in the field, you can earn qualifications in a particular area of coding. Since medical coding demands attention to detail, many coders prefer coding in one specific field, for example Cardiology, Neurology, or Psychiatry.

Medical coders do not need a bachelor's or master’s degrees, but they must have knowledge in anatomy, physiology and medical terminology education. The training programs partners with the American Academy of Professional Coders, to provide instruction in the necessary fields, such as anatomy, physiology, medical management, coding and medical terminology.

The advantages of a career in medical billing and coding

    • Medical billing and coding career has become desirable for the people interested in the healthcare industry. These healthcare professionals work in order to maintain the accuracy of the billing services of healthcare providers
    • The training necessary in becoming a billing or coding professional is a short term training that gives you the opportunity of becoming able to practice the job. People only need to sign up for a training program that can be completed in approximately one year.
    • People who choose this career path have a more flexible schedule. It is the perfect career for people who want to work in the medical field but also want to keep a balance between work and personal life. As experience is gained, adapting the work schedule to your needs will become much easier.
    • You can change the environment you work in. As every medical field needs a professional in coding and billing, you can choose from different settings. A hospital, a doctor’s office, or even your home, as many companies also offer remote jobs.
    • You will be an important figure in the healthcare system. Without professional in these fields, keeping the medical history and sending the information to the units and to the insurance companies becomes incredibly difficult as time passes by. Since more people are aging, the processing of the illnesses and of the receipts multiplies and the absence of these jobs would considerably slow down the entire mechanism. Therefore, choosing such a career would absolutely make a difference.

On the other hand, when choosing such a career path, you also have to be aware of the fact that working long hours in front of a computer will be necessary. This is not a career for people who like working in the field, or want an active job. You also have to be a detail-oriented and patient person, who can concentrate when a more complicated situation appears. Maybe some days the lists of claims will be large and the person who works on this job must pay attention to every detail, since the work is really important.

Why are medical billing and coding important?

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Medical billing is important, due to the fact that it ensures a smooth operation between fields. Medical biller specialists understand the medical regulations and the policies of the insurance companies, either private, or public. The training offers knowledge of bill adjustments, claim denial resolutions and these components must ensure an improved flow throughout the practice.

Medical coding is indeed vital as it can affect medical care, due to its direct link to insurance reimbursements. In today’s medical environment, doctors are required to list conditions, illnesses, diagnoses and having the proper coding ensures the insurance companies the correct codes required for appropriate payment.

References:

Is Medical Coding the same as Medical Billing?

The truth about medical billing and coding as a career choice (2016, June 23).

Medical billing and coding online. Billing and Coding programs online.

Ensuring payment flow. Medical billing and coding play a pivotal role in practices and hospitals. (2016, July 10).

Medical Coding: Hospital-Based

Medical Coder Certificate – St. Petersburg College

What is medical coding? – Carrington.edu

Medical Billing and Coding School Online | Penn Foster Career School

Medical Coding Program | Medical Billing and Coding Training

Medical Billing and Coding Online Courses | Ultimate Medical Academy

 

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Suzanne

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