Defining medical coding and billing?

Health insurance companies do not pay medical practitioners for the services they rendered in the absence of claims. With a doctor busy seeing patients everyday and their secretaries swamped with clerical work, an extra person is needed to do the tedious job of submitting and following up on claims submitted to insurance companies. Widely considered the fastest-growing disciplines in health care, this is called Medical Coding and Billing.

The responsibility of a Medical Coder and Biller includes recording and processing patient data including treatment records, insurance information, bills and received payments. They can work in the hospital, a doctor’s office, any health facility, and nowadays, they can even work from home. Although they often work in tandem, A Medical Coder is actually different from a Medical Biller. Some specialists opt to be both.

What is medical coding?

A medical coder’s duty includes translating the diagnosis of the medical practitioner into code form in a classified system wherein the amount an insurance company can reimburse has been determined. A medical coder should be knowledgeable in the prevalence of illnesses and diseases, and should be familiar with the international classification of diseases – the standard being used in all medical facilities around the world.

The current version being used by Medical Coders in the United States is called the ICD-9-CM, where 17,000 codes for diseases, injuries, diagnosis and treatments have been outlined. On October 1, 2014, however, the United States Department of Health and Human Services will switch to the ICD-10 system which has more than 141,000 codes. There are training programs already offered in schools to help Medical Coders through the transition.

A Medical Coding Specialist is required to have an associate degree in medical billing and coding. This course includes medical courses such as anatomy and combines it with healthcare reimbursement methods. Although not required, a certification gives a Medical Coder an advantage. A certified Medical Coding Specialist should be a graduate from an associate degree program and should pass the American Health Information Management Association or AHIMA test. In a 2010 survey conducted by the AAPC, they found that certified medical coding professionals earn $8,000 more than uncertified medical coders.

What is medical billing?

A Medical Biller ensures that an insurance company pays a medical practitioner. This involves coordinating all patients visiting a doctor everyday, managing their payments and submitting the claims to the insurance companies. They work closely with patients to determine their payment plans and they help in identifying and resolving complaints on bills. They are also in charge of following up on delinquent accounts.

This profession also includes a delicate balance between customer service and understanding different medical billings. Their responsibility lies on ensuring that their employer receives the proper reimbursement for the medical services they have rendered. Just like a medical coder, a medical biller can work in the hospital, a doctor’s office, or from home.

A high school graduate can become a medical billing specialist with the help of a certification exam from the American Billing Association or AMBA. It is highly recommended however for medical billers to earn an associate degree. To get that associate degree, classes involving basic medical terminology and different math and billing subjects are required. Since medical billers are usually paired with medical coders, an understanding of medical coding is also important. This will improve your job prospects, will make you better prepared for your certification test, and will also open doors for a more competitive salary.

The U.S. Bureau of Labor Statistics says Medical Coding and Billing is one of the fastest growing industries in healthcare today. Demand for this occupation is expected to increase in the coming years. If you have a certification in health information, perhaps now is the time for you to consider a career in this field.

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