By DeVry University
The medical billing and coding profession is a popular area of focus for many of today’s students, thanks to regular industry and job growth. In fact, according to the Bureau of Labor Statistics the medical billing profession is projected to grow by 11% between 2018 and 2028. Demand for inpatient services is also rapidly increasing as the US population ages—in fact, the share of the US population aged 65 or over is expected to double by 2050. This will likely increase the need for more healthcare professionals of all kinds.
With statistics like these, it’s no surprise that medical billing and coding is a trending career path. Read on to get answers to some of the most commonly asked questions – like what is medical billing and coding and how can someone prepare to enter this growing field.
Medical Billing and Coding 101
Let's start at the beginning: "What is medical billing and coding?" Simply put, it is the process of applying codes to health records and claims and then submitting those claims to the companies covering the cost of the service or treatment, such as insurance agencies. It is broken down into two primary roles: medical coders and medical billers.
Medical coding involves transforming everything associated with medical visits – from diagnoses to services and equipment – into alphanumeric codes that are universal to the medical community. Medical billers negotiate and arrange payments between health insurance companies, healthcare providers and patients. They are responsible for submitting medical claims to insurance companies or government payers such as Medicaid and Medicare.
Medical billing and coding go hand-in-hand because coding professionals apply these codes during the process of medical billing. Together, medical billers and coders take the information from the medical visit, assign codes and thereby create the insurance claims to be paid.
Medical billing is a complex and important element of the modern healthcare system. When you visit your doctor, there’s much more going on behind the scenes than a simple one-on-one interaction. Rather, there is a sophisticated system of information and payment transactions that occur in the background which medical billers and coders help facilitate.
Without medical billers and coders, today's increasingly complex healthcare system could not function. The financial cycle of the healthcare industry is of the utmost importance to ensure that patients receive the best care possible. We rely on medical billers and coders to make sure that the financial side of the healthcare system is properly maintained and that transactions are well-documented.
Medical coders are responsible for staying up-to-date with the latest coding regulations and standards and working with healthcare professionals to ensure that medical records correctly reflect their patients' care.
Medical coders assign standardized alphanumeric codes to the following items:
- The diagnosis given to the patient.
- The medical reasons for whatever treatments and supplies the patient received.
- The list of treatments, supplies and services the patient received.
- Any medical conditions or other circumstances that impacted the treatment and services the patient received.
These codes give payers insight into the process and end result of the care the patient received.
Medical billers are responsible for submitting technical documents and medical claims to insurance companies in a timely manner. A medical biller may be employed in a doctor’s office, a hospital, a senior care home, a physiotherapist’s clinic or any other healthcare facility.
Below, we’ve listed some of the most common job duties expected of medical billers:
- Following up on claims left unpaid by health insurance companies or payers.
- Cross-referencing insurance payments for regulatory compliance and accuracy.
- Reviewing and checking patients’ bills for completeness.
- Checking patients’ benefits and eligibility for treatment coverage.
- Obtaining pre-authorizations and referrals for specific procedures.
- Using billing software to prepare and transmit claims.
- Updating spreadsheets with sensitive patient-related data and payment information.
Of course, there may be other duties that an employer requires a medical biller to perform throughout the day. Generally, medical billers are flexible employees who can respond to a variety of demands in a healthcare context and regularly receive new training and on-site education to assist in performing a wider array of administrative tasks.
Understanding the Three-Party Billing System
Technically, there are three parties involved in the billing and coding processes of the healthcare industry:
- The first party to the transaction is the patient.
- The second party is the healthcare company that offers care services, such as a hospital, clinic, outpatient facility or rehabilitation center.
- The third and final party to the transaction is the health insurance company or payer.
You can think of medical billers and coders as the glue that binds all three parties together within the US healthcare system. The medical biller arranges for payment between all three parties in the transaction by ensuring that the healthcare provider receives payment for the services rendered to the patient from their insurance company.
Medical billers receive "superbills" which contain sensitive information about the patient and their procedure, which they then convert into a bill for the patient's insurance company. In the industry, the bills sent to insurance companies are called "claims" and they include detailed reports on the patient's medical history, health insurance coverage and the procedure they received.
Without medical billers, healthcare professionals such as nurses, doctors and therapists would not be able to receive payment for the vital services they perform. Therefore, medical billers play a crucial role in the healthcare industry.
Becoming a Medical Billing and Coding Professional
Studying to become a medical biller and coder often requires a foundational education in health sciences as well as hands-on training with health information technology. The DeVry University Medical Billing and Coding certificate program requires the following coursework in order for a student to graduate:
- BIOS105: Fundamentals of Human Anatomy and Physiology with Lab
- BIOS267: Pathopharmacology
- HIT111: Basic Medical Terminology
- HIT120: Introduction to Health Services and Information Systems
- HIT141: Health Information Processes with Lab
- HIT203: International Classification of Diseases Coding I with Lab
- HIT205: International Classification of Diseases Coding II with Lab
- HIT211: Current Procedural Terminology Coding with Lab
- HIT230: Health Insurance and Reimbursement
- HIT252: Coding Practicum and Review (CCA Exam)
The courses listed above provide background in medical terminology, disease coding, health informatics processing, record processing and the US health insurance industry. Together, they provide students with a combination of theoretical, practical and hands-on knowledge.
What Are Common Job Titles for Medical Billers and Coders?
With the right education and job qualifications, medical billing and coding professionals may pursue job titles such as:
- Medical Records Clerk
- Medical Records Technician
- Health Information Clerk
- Medical Records Coordinator
How Much Do Medical Billers and Coders Get Paid?
The average medical coder and medical biller salary depends largely on one’s experience in the industry, the extent of his or her post-secondary education and their state of residence. Salaries can also vary based on whether the individual is employed by a hospital, doctor’s office, nursing home or other healthcare establishment, as well as whether or not the individual opts to take advantage of overtime pay opportunities. To gain a better understanding of the earning potential in this career field, we recommend referencing the data provided by the Bureau of Labor Statistics.
What to Look For in a Medical Billing and Coding Program
To enter a field that's growing as rapidly as medical billing and coding, it's important to be up-to-date on the latest technology and industry insights. Here are a few things to look for in a medical billing and coding program:
- Technology: It's no surprise that managing thousands of medical bills – and the codes that go along with them – certainly requires the use of technology. AHIMA's Virtual Lab (VLab) is one example of a widely used program by students preparing to pursue work as medical billers and coders. VLab is an online lab environment that provides first-hand experience working with medical records and health informatics. The experience gained in the VLab environment helps students get the practice they need to begin their careers in the medical records field with confidence.
- Partnerships: As an added benefit, universities may partner with a variety of industry leaders to provide a more comprehensive educational experience for students. One example is The American Health Information Management Association (AHIMA), the world’s leading health information management association.
- Exam Prep: To expand your opportunities as a medical biller and coder in the US, graduates should consider obtaining one of the three most common nationally recognized medical billing and coding certifications: AHIMA’s Certified Coding Specialist (CCS), AHIMA’s Certified Coding Associate (CCA) or AAPC’s Certified Professional Coder (CPC). Look for a program that not only includes exam prep courses but also covers the fees for at least one exam attempt.
- Accreditation: Companies want to know that their employees received a thorough education – and graduating from an accredited institution is a critical way to demonstrate this.