If you’re interested in a healthcare career that doesn’t involve directly administering care to patients, medical coding and medical billing may be a good choice. One of the first questions you might have is, how difficult is this job? If you’ve never done billing and coding before, you may think it is intimidating, or you may think it is very easy. The answer is somewhere in between, and like many skilled jobs, doing it correctly requires specialized skills and insights.
This article is to give you a clearer perspective of what medical billing and coding entails, and to help you decide whether it is a career you want to pursue. If you do decide to become a medical biller and coder, the training program at Campus can help you get certified in about 10 months.
What Do Medical Coders and Billers Do?
Though the terms medical coding and medical billers are often used together as one term, these are two different roles. Depending on the workplace, these roles may be separated into two distinct jobs, or may be combined into a single position.
Medical Coding
Medical coding is the review of medical data from a patient visit, analyzing that information and encoding it in datasets which can be universally understood by physicians, healthcare workers, and insurance companies (payers).
Medical coders transcribe a patient visit and physician's treatment into a series of universally agreed-upon codes. These codes are used by health care providers, hospitals, insurance companies to create a record of a patient's visit and submit an insurance claim. Each code has guidelines on how they can be used, so accuracy is essential.
Claims are submitted using standardized codes used throughout the healthcare industry. Some of these include the International Classification of Diseases (ICD) and Current Procedural Terminology (CPT). Each code correlates to a diagnosis, procedure, treatment, prescription, or medical supply. Medical coders must accurately find the code that matches each aspect of the patient visit and input them in medical records and insurance claims.
Medical Billing
Medical billers submit claims to patient’s health insurance payers using the correct medical codes so the procedures and treatments are properly compensated. Billers also follow up with the insurance companies to make sure claims are not denied and the revenue cycle continues smoothly.
A medical biller will also send patients the bill for the portion for which they are responsible, ensuring timely payments are made.
Importance of Correct Billing and Coding Procedures
Billers and coders must ensure the right medical codes are put into electronic health records and submitted to insurance claims. If the incorrect codes are submitted, the claim may be denied, and the medical office may not be compensated for services provided. The patient bill may be affected by this delay, causing the portion they are responsible for to be greater than it need be. Medical facilities are also audited periodically for accuracy in medical billing. The medical office must stay compliant with current healthcare laws and regulations, and avoid legal issues and fines associated with incorrect billing practices.
Is Being a Medical Biller and Coder Hard?
Is it difficult being a medical biller and coder? Like most jobs, there are challenging aspects, as well as lots of upsides.
Medical billers and coders are often audited internally by a supervisor in the organization for accuracy. Most employers are looking for a 95 to 98 percent accuracy rate. Each organization will also have a quota on the number of charts you must process each workday. The number you have to reach will also vary based on the employer and the efficiency of the processes they have in place.
Being an efficient medical coder and biller also requires continuous learning, as some medical code sets like CPT® are updated every year. HCPCS codes are also updated yearly, with Level II codes updated quarterly. Keeping up with the hundreds of code changes across these code sets means learning is a continual process as a medical coder.
Insurance guidelines, federal government guidelines, and industry regulations also change periodically, so keeping up with these procedures is a must.
There are also different types of procedures that have their own intricacies for coding correctly, and learning the correct codes for each treatment can be challenging at times.
Some healthcare facilities have coding software which will help you look up the correct codes for each procedure or treatment. This can be useful because there are tens of thousands of codes in each coding system, with new additions and revisions made every year.
If you like solving problems and have an analytical mind, this might be the perfect job for you. Some healthcare providers made medical billing and coding a fully remote position after the COVID-19 pandemic, so if you are highly organized and efficient, you can work from home and skip the commute.
What Education and Training Do You Need to Be a Medical Coder and Biller?
Do you have to take classes to work in medical billing and coding? Because of the importance and complexity of medical coding, most employers are looking for candidates that have the proper certification. The State of California does not have set educational requirements for working as a medical biller and coder, but the majority of medical offices and hospitals will look for a candidate with certification.
Medical coders are also required to submit continuing education units (CEUs) periodically to remain certified. Due to the constant changes in compliance, codes, and regulations, this is necessary so medical coders stay up to date with the current standards. Organizations like the American Academy of Professional Coders (AAPC) have resources that can help you find qualifying CEU classes at little to no cost.
Secondary and post-secondary degrees are not usually a requirement to become a medical biller or coder unless you are going into management or auditing.
Skills for Being a Medical Biller and Coder
This equates to the addition of roughly 37,100 new positions. So, growth-wise, now may be a good time to enter this field. You might also find this a rewarding career if you have certain qualities that are beneficial in this position, such as being analytical, being detail-oriented, and having good communication skills.
Analytical Mind
Finding the right medical codes for each patient chart and visit is a job that requires logic and analysis. Some categories are trickier than others. A person who likes solving puzzles, who analyzes information, and can retain knowledge will thrive as a medical coder.
Attention to Detail
Medical codes are extremely specific. Each alphanumeric or numeric code corresponds to a very specific procedure or medical supply. Paying attention to each code to make sure you are getting the right one is mandatory. You’ll also need to review the patient claims and electronic health records for accuracy and compliance.
Clear Communication
Medical billers and coders correspond with several teams, including the insurance companies, medical offices, and government agencies. Sometimes medical billers need to get clarification on details or follow up on claims several times. Professionals with excellent written and verbal communication skills will excel as medical billers and coders.
Problem Solving Skills
Medical coding requires strong problem-solving skills. Finding the right codes can be straightforward in some categories, but other categories take a lot of diligence and insight to get the correct codes.
Adapting to New Software
Medical coders often use specialized software to help them find codes and input them into electronic health records. Computer software is used to submit claims to the insurance payers, verify payments, and authenticate patients’ insurance coverage. Being able to learn new software and computer systems quickly will be a great help to your career.
Customer Service
Medical billers and coders sometimes must explain charges, credits, and portions of a patient bill. Some of the bills might be written in medical jargon, so the medical biller must translate the vernacular into clear language the patient can understand. Maintaining stellar service with respect and dignity is part of being a truly professional medical biller.
Is Medical Coding a Good Career?
Jobs for medical billers and coders are expected to grow 9% between 2023 and 2033, according to the Bureau of Labor Statistics. About 16,700 jobs will be for medical billers and coders over the next decade. According to the BLS, medical coders and billers earned a median salary of $48,780 per year and $23.45 per hour in 2023.[1]
Become a Medical Biller and Coder in About 10 Months
If medical billing and coding sounds like an intriguing career, the online training program at Campus can help you get trained and certified to begin your billing and coding career in ten months. The training program is followed by an externship in the Greater Sacramento area. Students can also take a similar program that is only online training without the externship, called Medical Billing and Coding Specialist. At the end of the program, students are ready to take the Certified Medical Reimbursement Specialist (CMRS) exam and start their medical coding and billing career.
If you want more information on the program, or financial aid, contact our Admissions team for more details.