What Is Medical Billing and Coding?

Medical billing and coding is the process of translating medical diagnoses and procedures into codes used in medical records and claims submitted to payers for reimbursement. Billing and coding are actually separate processes that are equally important to the healthcare revenue cycle, ensuring that providers are accurately reimbursed for their services.

The question what is medical billing and coding is answered by the people who perform these vital functions. Their work ensures that services provided by physicians, hospitals, surgery centers and others are translated into the correct codes and submitted to payers (such as insurance companies, government programs like Medicare or patients) for reimbursement.

In this article, we will thoroughly explore medical billing and coding and why you may want to pursue this career path.

Medical billing and medical coding are two distinct but interconnected parts of the healthcare system. Medical coding, which is typically the first part of the process, involves applying the correct codes to health records and claims. Medical billing involves submitting claims to payers.

While medical billers and medical coders are two distinct careers with different skillsets, they may share similar duties or professional qualifications. Their work is essential to maintaining the financial health and successful operation of any healthcare facility. 

On a typical day, a medical coder may perform these duties:

• Review medical documentation and translate notes into ICD or Healthcare Common Procedure Coding System (HCPCS) codes
• Communicate with medical providers and insurance companies or other payers
• Correspond with healthcare providers to obtain or confirm details that will enable them to “code to the highest degree of specificity,” thereby reducing claim denials
• Use digital tools such as coding software and patient record platforms

Medical billers take over where the coders have left off, ensuring providers and facilities receive correct payment for their services. On a typical day, they may:

• Use diagnosis and treatment codes provided by medical coders to create and submit new reimbursement claims
• Review codes and claims to ensure they are accurate and represent the level of care provided
• Communicate with providers, coders and insurance companies to work out any discrepancies or disagreements
• Work with patients to get reimbursement for remaining costs not covered by insurance companies or other payers
• Communicate with healthcare providers, healthcare facilities and insurance companies to get pre-authorization for treatments or procedures as needed

These medical billing and coding examples will show you what medical billers’ and coders’ day-to-day tasks look like.

According to the WHO, one of the best snapshots of a country’s wellbeing comes in the form of its health statistics. Now in its 11^th version, the ICD is the bedrock for health statistics. Mapping the human condition from birth to death, any injury or disease we might encounter in life – and anything we might die of – is coded. These health statistics form the basis for almost every decision made in healthcare today:

• Understanding what people get sick from, and die of (morbidity and mortality)
• Mapping disease trends and epidemics
• Deciding how to program health services
• Allocating healthcare spending
• Investing in research and development
• Planning new healthcare facilities

Because ICD codes are used to determine where best to invest resources, they can have enormous financial importance. As the foundation of health insurance billing, they are critically connected with healthcare finances.

The ICD is truly an international language, providing a common vocabulary for recording, reporting and monitoring health problems. Today, if a doctor in another country cannot read a person’s medical records, they can understand a patient’s condition just by reading the ICD codes. This would have been unimaginable 50 years ago.

As in just about any career, pursuing career opportunities in the medical billing and coding profession requires the right preparation and some dedicated work. It’s important to choose online classes for medical billing and coding that help prepare you to pursue the CPC, CCS or CCA certification exams after graduation.¹

Your medical billing and coding training should also provide ample hands-on opportunities with healthcare applications such as encoders and electronic health record systems.

At DeVry, we offer two Medical Billing and Coding (MBC) certificate programs:

• Medical Billing and Coding
• Medical Billing and Coding – Health Information Coding

Offered 100% online and designed with busy, working students in mind, each program offers hands-on learning and built-in preparation for industry certification exams.

Our online Medical Billing and Coding Certificate can prepare you to begin your MBC journey by providing you with the knowledge, skills and abilities needed to function as an entry-level coding specialist and pursue the CCA Certification Exam.¹

Our MBC – Health Information Coding Certificate can help those with previous coursework or experience prepare for more advanced entry-level positions. This specialization introduces more detailed instruction on related concepts and helps prepare you to pursue the CCS Certification Exam.¹

Students who earn either certificate can apply credits earned toward our Associate Degree in Health Information Technology or Bachelor’s Degree in Technical Management with a specialization in Health Information Management or Health Services Management.²

Topics in our online Medical Billing and Coding Certificate program include:

• Health Insurance and Reimbursement
• Classifying Medical Data
• Process Information
• Current Procedural Terminology
• Health Services and Information Systems
• Document and Record Information
• International Classification of Diseases Coding
• Medical Terminology

To pursue a career in medical billing or coding, you'll generally need to complete your training and education, then obtain at least one medical billing and coding certification to demonstrate your knowledge, skills and experience to employers.

The importance of certification cannot be overstated. There are two primary certifying bodies in the United States: The American Health Information Management Association (AHIMA) and the American Academy of Professional Coders (AAPC).

AHIMA offers 3 three medical billing and coding certifications: 

• Certified Coding Associate (CCA®)
• Certified Coding Specialist (CCS®)
• Certified Coding Specialist – Physician-Bbased (CCS-P®)

AAPC offers 6 six certifications: 

• Certified Professional Coder (CPC®)
• Certified Professional Biller (CPB™)
• Certified Professional Coder & Biller (CPC® + CPB™)
• Certified Outpatient Coder (COC™)
• Certified Inpatient Coder (CIC™)
• Certified Risk Adjustment Coder (CRC™)

To receive any of these certifications, you must sit for and pass its corresponding exam, among other criteria. While some roles may require a specific credential, passing any of these exams can help you demonstrate your knowledge and skills in medical billing and coding to future employers. We can help you understand the specifics of the medical billing and coding exams and determine which is the right fit for you. 

Our online medical billing and coding courses can help you prepare to take the exams for these certifications¹:

• Certified Professional Coder (CPC): This certification from the AAPC indicates that you have a strong grasp of medical billing code sets and evaluation and management (E/M) principles. The CPC exam also tests your ability to understand and properly implement documentation and coding guidelines.
• Certified Coding Associate (CCA): From the AHIMA, the CCA certification demonstrates indicates your competency with the various processes and skills needed for classifying medical data using patient records.
• Certified Coding Specialist (CCS): Also from the AHIMA, the CCS certification requires you to showcase a high-level coding knowledge and commitment in all medical settings. Passing the CCS exam may be useful for those more interested in the coding side of medical billing and coding versus the billing side.

The medical billing and coding career path is wide, encompassing many different occupations, job titles and daily responsibilities.

According to the U.S. Bureau of Labor Statistics, demand for medical records specialists is expected to grow at a rate of 7% from 2021 to 2031 on a national level, keeping pace with the level of demand for all occupations³.

A partial list of medical billing and coding careers you may consider after completing our online Medical Billing and Coding Undergraduate Certificate includes:

• Medical Records and Health Information Technician: These technicians organize, manage and code health information data using medical billing and coding skills to ensure that records are easy to access and interpret.
• Billing Specialist: Billing specialists help keep healthcare facilities running by overseeing the billing process for customers and patients, including processing and organizing payments and financial records.
• Insurance Claims Specialist: These individuals facilitate the processing of claims and may serve as the liaison between the insurance company, the provider and the insured. Claims specialists help patients receive the proper contribution from their insurance and make sure they don't overpay for their procedures.
• Medical Biller: Medical billers manage payments and insurance claims for the provider to ensure that payments come through on time and accurately reflect the procedures a patient received.
• Collections Specialist: Collections specialists work with patients to resolve bills, collect payments and resolve any billing or coding errors.
• Coding Professional: Coding professionals ensure that patient records are entered with the correct codes and manage billing with patients and insurance companies.

Positions for medical billers and coders may be available in a variety of settings throughout the healthcare industry. Here’s a list of the settings where they’re likely to work:

• Hospital: A large healthcare provider that may have multiple facilities within a network, commonly referred to as a health system. It may provide both inpatient and outpatient medical care.
• Large Medical Practice: A group practice comprised of many healthcare practitioners. It may have multiple locations and is likely to offer a single specialty, like oncology or orthopedics.
• Small Medical Practice: A single practitioner or small group practice of a few physicians. As with a large practice, it could be a single-specialty or multi-specialty practice.
• Dental Office: A single practitioner or group practice where dentists and hygienists provide services.
• Ambulatory Surgical Center (ASC): Healthcare facilities that offer same-day surgical care, including diagnostic and preventive procedures.
• Healthcare Consulting Service: Consultants that help healthcare providers design, develop and implement solutions to improve performance and profitability.
• Insurance Agency: Health plan providers that reimburse healthcare facilities for the services they have provided to their members.
• Government Agency: These may include the National Center for Health Statistics or state Medicaid departments.
• Law Firm: Legal practices that investigate fraud claims associated with incorrect billing procedures within the healthcare industry.
• Educational Institution: Colleges, universities and technical schools that provide certification or degree programs in healthcare management and administration.

You may have heard about people doing medical billing from home. The answer to whether this would be an option for you depends on factors like your role and experience level, and certainly will vary by employer. Some companies have come to adopt work-from-home policies for medical billers and are also exploring hybrid models, allowing the biller to split their time between home and the office.

If you think working from home would allow you to achieve a more favorable work-life balance, then it may be worth exploring. Some of the potential advantages of working from home include:

• Eliminating the daily commute: This puts more hours back in your day, allowing a healthier work-life balance, and can also put more money back in your pocket by eliminating the transportation costs associated with commuting to work.
• Flexible work schedule: Your employer may give you the flexibility to work the schedule that fits best for you, including setting your own work hours or condensing your workweek.
• More family time: Working from home may give you the freedom to take breaks to tend to personal or family needs throughout the day.
• Increased diversity: There may be increased potential to work virtually, with a more diverse group of colleagues from different cities and backgrounds.

If working at home is important to you, be sure to discuss this with the hiring manager during your interview process. Remember that while a job may start out as an on-site position, some employers may be willing to modify the arrangement after you’ve gained experience in your role.

As with any occupation, there is no singular career pathway to become a medical biller and coder. There are, however, some general steps you can take as you work toward that goal, beginning with enrollment in an undergraduate certificate program. For more information, see our Step-by-Step Guide to Becoming a Medical Biller or Coder.

As the healthcare system in the United States continues to expand in size, breadth and complexity, medical billers and coders may continue to play a vital role in the revenue cycle and the overall quality of patient care as advocates for both the patient and the provider. If medical billing and coding sounds like a career path you’d like to explore, use the links below to learn more about the multi-faceted role of professionals in medical billing and coding and why it may be the career for you.