What Is Medical Billing & Coding?
You visit a physician’s office or a hospital to see the doctors, nurses, and therapists who provide health care.
But there’s another group of people behind the scenes who you don’t see. These people do the administrative work, including medical coding and health insurance billing.
Medical billing and coding professionals (CPCs) translate your healthcare provider’s diagnosis and treatment into standardized codes that get sent to insurance companies and government agencies.
The healthcare industry uses a coding system to be sure the treatments and procedures you received match insurance billing and government standards.
Coders and medical billers — known collectively as medical records and health information technicians — maintain the healthcare revenue cycle. They help ensure healthcare providers get reimbursed by insurance companies quickly and efficiently.
To do their jobs, billers and coders need to understand how the medical insurance system works. They also must know how to code the information correctly to expedite claims, and what to do if a claim is denied.
Their specialized knowledge, skills, and efficient job performance make medical coding professionals valued members of every healthcare team.
What Does A Medical Coder Do?
Medical coding is the first step in recording patient data, both for patients’ medical records and for billing purposes.
Medical coders use intricate classification systems to translate medical information into codes which can be entered into billing systems and patient medical records.
These classification systems are ICD-10-CM, HCPCS Level II and CPT which we’ll discuss more below. This process allows everybody who touches a patient’s records to have a universal understanding of the patient’s diagnosis, as well as the tests and procedures that were ordered and delivered.
It is a medical coder’s job to make sure the correct code is identified and recorded.
What Does A Medical Biller Do?
Once a healthcare professional has provided services to a patient, a bill needs to be submitted for payment. These bills get sent to insurance companies and government agencies as well as to patients. Bills must be accurate to facilitate quick payment. Here are some of the duties a medical biller may perform:
- A medical biller reads and reviews medical records — which may or may not have been coded — and translates them into a bill.
- Medical billers then have to keep track of the bill to make sure it gets paid.
- To ensure accuracy and quick reimbursement, medical billers may need to gather patient and insurance information before the patient sees a doctor or nurse.
- Getting patient information first can expedite the insurance claims process by making sure the patient has health insurance coverage. If needed, the medical biller can get preauthorizations, collect patient payments, and check all billing for accuracy before submitting it.
- Medical billers also record payments as they are received.
Medical Billing & Coding Salaries
Medical billers and coding professionals both have unique skill sets and responsibilities, but medical billers and coders earn roughly the same amount and are both classified as medical records and health information technicians.
According to the annual salary survey conducted by the AAPC (American Academy of Professional Coders), the average medical coding salary is $53,396, with certified coders earning 33% more than non-certified coders.
The Bureau of Labor Statistics estimates this profession will add 29,000 more positions by 2029.
How to Earn More Money as a Medical Coder or Biller
Medical coders and billers can earn more money by earning certifications:
- Coders with one certification earn an average of $55,923 per year
- Those with two certifications earn an average of $64,890 per year
- Those with three or more credentials earn an average of $70,608 per year
Along with these average earnings, billing and coding jobs tend to come with benefits including health insurance, disability insurance, vacation and sick leave, and retirement plans.
Some employers offer childcare reimbursement, tuition reimbursement, and other perks.
How to Start Working in Medical Coding & Billing
One of the most appealing aspects of medical coding and billing is the fact that it’s possible to earn your certification or diploma in less than one year.
If you choose this career path, you have the option to earn a certificate, diploma or associate degree in medical billing and coding. You’ll then take special classes on the job’s important responsibilities.
Coding courses and certification exams — not research papers and diplomas — help determine whether you’re ready to enter the workforce as an entry-level medical biller or coding professional.
What You’ll Learn in a Medical Coding & Billing Program
Both medical billing and medical coding certifications require that students learn federal coding standards in:
- CPT (Current Procedure Terminology standardized by the American Medical Association)
- ICD 10-CM (Coding standards for diseases and disorders issued by the Centers for Medicare and Medicaid Services)
- HCPS (Coding standards for medical services and supplies issued by the Centers for Medicare and Medicaid Services),
Because of the similarities between the two careers, some programs combine billing and coding into a single curriculum that provides dual certification. If you prefer to pursue just one path, there are differences between the two curricula.
Medical Billing Program Courses
The Medical Billing curriculum will include coursework in:
- Medical Terminology
- Medical Insurance Principles
- Medical Reception
- Medical Billing Technology
Medical Billing Certifications
These courses prepare you for taking tests to provide the following credentials:
- Certified Professional Biller (CBP) issued by the American Academy of Professional Coders
- Certified Medical Reimbursement Specialist (CMRS) issued by the American Medical Billing Certification
- Certified Medical Billing Specialist (CMBS) issued by the Medical Association of Billers
Medical Coding Program Courses
Medical Coding curriculum will include coursework in:
- Anatomy
- Pharmacology
- Medical Office Procedures
- Medical Records
Medical Coding Certifications
These courses prepare you for taking tests to provide the following credentials:
- Certified Professional Coder issued by the American Academy of Professional Coders
- Certified Coding Associate (CCA) issued by the American Health Information Management Association
- Certified Coding Specialist (CCS) issued by the American Health Information Management Association
- Certified Coding Specialist: Physician-based issued by the American Health Information Management Association
Medical Coding & Billing Certification Programs
Medical coding and billing certification programs are available online or in person. Enrollment in either type of program offers its own advantages and disadvantages.
In-Person Programs
While learning in a traditional classroom setting gives students face time with an instructor and other students along with hands-on training, it also requires that you adhere to the institution’s schedule.
This may limit access for students who do not have a program nearby, or who are pursuing their education while also working at another job or attending to family responsibilities.
Online Programs
By contrast, online medical billing and coding training programs offer scheduling flexibility allowing you to study when you are available as long as you complete your coursework. You can access programs anywhere without leaving your home, and these programs are often less costly.
But you give up access to face-to-face support from teachers and the comradery of interacting with fellow students, and you need access to technology and an internet connection.