By DeVry University
Interested in medical billing and coding, but not quite sure what to expect? Explore this infographic to learn the basics. Whether you choose to pursue a medical billing career or a medical coding career, you can get to know the job tasks and business processes that make up this popular field – along with the education requirements needed to get started.
A Growing Need for Medical Billing and Coding Professionals
Thanks to an aging U.S. population, healthcare needs are continuing to grow, as are jobs within the industry1. According to the United States Census Bureau, the US population over the age of 65 is expected to double by the year 2050, going from 43.1 million in 2012 to a projected 83.7 million by 2050. Relatedly, national health spending is projected to increase over the coming years, with the average annual growth rate projected to continue at 5.4% from 2019 to 2028.
Many students find medical billing and coding particularly appealing because of its current and projected growth. According to the Bureau of Labor Statistics, this field is expected to see an 8% growth in jobs between 2019 and 2029, which is much faster than the 4% average growth rate projected for all occupations2.
How Medical Billing and Coding Works
Medical billing and coding professionals work to make sure that hospitals and medical organizations properly format billing information so that they can be paid through the patient's insurance carrier or other payment method. This is an important job because mistakes in coding and billing can cause the denial of a claim, which can have a negative impact on a healthcare organization's revenue cycle management.
It’s important to note that medical coders and medical billers are two separate roles. After a patient makes a medical visit, a coder translates visit information into a universal code and a biller arranges and submits claims to relevant agencies using those codes. If you’re pursuing a medical coding career you’ll need both technical and coding knowledge, whereas those interested in a medical billing career path should be prepared to manage regular interactions with insurance agencies.
Specifically, those pursuing a medical billing career might focus on:
- Reconciling unpaid claims
- Auditing records and payments for regulatory compliance and accuracy
- Reviewing patient benefits and eligibility for treatment coverage
- Preparing authorizations and procedure referrals
- Transmitting claims using billing software
- Recording sensitive patient and payment data
All of this can only happen after the medical coder has taken the following information and translated it into universal code:
- The diagnosis given to the patient
- The list of treatments, supplies and services the patient received
- The medical reasons for whatever treatments and supplies the patient received
- Any medical conditions or other circumstances that impacted the treatment and services
Medical billers and coders might work for a small physician's office, a larger healthcare practice, a clinic, a home healthcare provider, a hospital or any other provider of healthcare services that would be paid by medical insurance.
Medical coders and billers must also have a strong aptitude for detail. When working with sensitive patient records it’s important that they maintain a strict protocol to ensure that the process is performed in compliance with regulatory requirements.
Medical Billing and Coding Certifications
Most medical billing and coding roles require a certification such as the CCA (Certified Coding Associate) or CCS (Certified Coding Specialist). The CCA demonstrates competencies across all settings, including hospitals and physician practices, while the CCS signifies that you’re a mastery-level professional skilled in classifying medical data (typically in a hospital setting). Oftentimes, the CCS can be a great step for professionals with experience in coding inpatient and outpatient records.
Get Started with a Certificate
1The Bureau of Labor Statistics states that Employment in healthcare occupations is projected to grow 15 percent from 2019 to 2029, on a national level, much faster than the average for all occupations, adding about 2.4 million new jobs. Healthcare occupations are projected to add more jobs than any of the other occupational groups. This projected growth is mainly due to an aging population, leading to greater demand for healthcare services. Local growth will vary by location.
2The Bureau of Labor Statistics projects 8% growth, at the national level, for the 2019-2029 period. Local growth will vary by location. https://www.bls.gov/ooh/healthcare/medical-records-and-health-information-technicians.htm3For the MBC certificate program, all but one course stacks into our Associate Degree in Health Information technology. For the AHIT program, all but one course stacks into our Bachelor’s in Business Administration degree with a specialization in Health Information Management. Program availability varies by location.
3For the MBC certificate program, all but one course stacks into our Associate Degree in Health Information technology. For the AHIT program, all but one course stacks into our Bachelor’s in Business Administration degree with a specialization in Health Information Management. Program availability varies by location.