Making a Career in Medical Billing

Learn the differences between medical billing and coding. Find out what is required to get a career as a medical biller or coder.

Medical billing and coding are classified as healthcare jobs, but they do not require an extensive focus on preventive care or performing complex procedures on patients. Instead, billing and coding focuses on administrative and financial tasks. Medical coding refers to taking information from medical records or clinical documents. Doctors and other healthcare specialists use a special shorthand, which medical coders translate into usable information for patients and insurance agencies. There are many levels of medical coding, with different systems used for diagnosing, procedure codes and clinical items, as well as individual codes for the facility.

Medical billing relies on information provided from medical code, but it is a separate process. Medical billers provide patients with all the financial forms to confirm their identity and insurance information. Medical billers also work with patients to create payment plans and determine what services are covered by insurance and what patients must pay for out of pocket.

Different Types of Medical Codes

The bulk of becoming a medical coder involves learning the different codes. The first type of code is ICD-10, which is used for diagnosing. These codes refer to injuries or medical conditions afflicting patients. There are two different sections of ICD-10 coding, CM and PCS. CM is clinical modification, which refers to general diagnostic coding. PCS is procedure coding system, which refers to any type of inpatient procedure performed in the medical facility.

Once translated, both of the codes are used in medical billing to explain what services the patient needed, as well as the severity of their condition. There are over 70,000 ICD-10 codes. The system is used internationally and is maintained by the World Health Organization.

The next types of codes are Current Procedure Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS). These codes provide greater details to ICD-10 coding. For example, a CPT code explains how many times a procedure was performed, or why it was medically necessary. HCPCS serve the same purpose, but are specifically for non-physician services. This includes getting a ride from an ambulance or documenting what medication the patient was on before arriving at the healthcare facility.

Charge capture codes are not as complex as the previous systems. These codes are customized by the healthcare facility and identify how much a service costs. There are several other custom codes, known as professional and facility codes. These are largely used to bill customers. Facility codes are used for internal costs, including hospital space, medical equipment, prescription drugs and other supplies.

Different Types of Medical Billing

There are two types of medical billing, front and back-end. Front-end billing starts when a patient first appears for an appointment. During this period, the patient fills out forms to confirm their identity and patient information, as well as insurance coverage. The bulk of the billing occurs in the back-end, after the patient is treated.

During this process, medical billers take all the information compiled by medical coders to determine how much the patient owes, as well as what services are covered by insurance. This information is also used to update medical files. Medical billers spend most of their time compiling paperwork for both patients and insurance companies. Medical billers frequently work with patients to come up with payment plans. If a patient misses a payment, medical billers must follow up with the patient to collect however much is owed.

Common Medical Billing and Coding Jobs

There are several different specialties available to coders and billers. Due to Covid-19, many of these jobs were performed remotely. In 2021, many billers and coders still work remotely, but are starting to transition back to office roles. Whether or not you can work remotely largely depends on the healthcare facility. Some positions may also vary based on the facility. For example, some hospitals combine or separate roles.

Medical records coordinators are responsible for updating patient information after a procedure. These documents are then handed to a medical coder, who reviews the record then compiles the code for insurance agencies. If there are any issues with the code, a medical coding specialist is brought in to analyze the data and correct any irregularities.

A medical billing manager oversees the billing department. In addition to managing employees, they also represent the facility during insurance negotiations. The bulk of medical billing is performed by a medical records clerk or analyst, who takes the information provided by coders and turns it into billable information.

Keiser University

If you are interested in medical billing and coding, Keiser University runs an extensive healthcare administrative program. The course covers general administrative practices as well as clerical practices to file insurance, reimbursement and compliance claims. There are courses available for multiple types of medical coding, basic healthcare information and medical office procedures.

Southwest Wisconsin Technical College

Southwest Tech is one of the top colleges for health information technology since the entire program is available online. However, you must complete an in-person internship at an approved healthcare facility as part of the graduation process. In addition to teaching medical coding, the program focuses on improving critical thinking and communication skills. There are also advanced courses available that cover more complex medical terminology, as well as healthcare law and ethics.

Pennsylvania Institute of Technology

The Pennsylvania Institute of Technology allows students to enroll in a fast-track medical billing and coding degree, which only takes nine months to complete. While it is not as comprehensive as other programs, it covers all the necessary information students need to get an entry-level position as a medical biller or coder. The program also has a greater focus on mathematics for healthcare professionals as well as strategic management for working in the healthcare community.