Insurance and government reimbursement in the medical field is an essential way to insure hospitals, labs and physician’s offices remain operational. This is the language of money. Like any language, it has its dialects that are fraught with confusion and constant change in federal regulation.
When a medical service is provided, a bill is issued with a medical code for each service listed. Medical codes are what dictate how a medical service or physician visit will be paid. They also determine the reimbursement rate for each service. Typically, a medical coder deals with diagnostic codes (ICD-9 codes), Evaluation codes (CPT codes) and hospital codes (HCPS codes). There are also codes for injections and other miscellaneous items. The codes and their associated services are listed by category with an associated number in what is called a coding manual. A coding manual is the virtual bible of the billing and coding industry. The American Medical Association (AMA) releases new coding manuals on an annual basis. These are purchased by medical facilities to stay current with regulatory changes.
In addition to assigning the proper code for reimbursement from a private insurance carrier or Medicare/Medicaid, a biller or coder must know medical terminology, charting techniques and the proper forms to file. An expertise in individual medical coding software is also essential. The software can be customized for each medical practice. It is designed to streamline the billing process, and prevent a never ending paper chase.
Medical billers/codes may work for a physician group, in a hospital, insurance company or for a billing provider retained by a medical office. They can also be found in doctors’ offices, nursing homes, rehabilitation centers, accounting and legal offices. .Many coders/billers work for a particular specialty such as pulmonology or nephrology.
The Job Outlook for this Field
Medical coders/billers are in high demand as more changes abound in the health insurance reimbursement at the federal level. Experience and specialization command more money, as does the medical venue of an employee. Hourly wages may start at about $10 and go as high as $40 an hour for a highly experienced medical biller/coder.
As is true in many professions, education counts! Certification is usually the rule for a medical biller/coder. Many two year colleges and online training programs provide the fundamentals necessary to obtain certification in each state. A certification exam is required after a period of internship or practicum experience. Most programs prepare students for the American Academy of Professional Coder’s exam and the American Health Information Management Association exam. The American Association of Professional Coders (AAPC) is a good resource to learn the requirements in a particular specialty and geographic area.
Day to Day Challenges
Just like any other profession, medical coding and billing has its everyday challenges. First of all, coders/billers must make sure a particular medical procedure or medical visit is properly coded for adequate reimbursement. An improper code will result in a rejection from an insurance carrier or government funding source. This is where the art of diplomacy comes in. This is especially true if a coder has grapple with the insurance company or approach a doctor for a corrected code. A coder/biller must always know the proper medical terminology, human anatomy and be able to read a physician’s handwriting. Physicians are ultimately responsible for issuing the right code that describes a medical condition or service to justify a billing. Unfortunately, many physicians are not current in their coding knowledge. They are also notorious for having terrible, illegible handwriting. Just take a look at a pharmacy prescription sometime.
Remaining current on all recent coding changes is also a major component of this job. Coding revisions are issued on a quarterly basis by the Centers for Medicare/Medicaid Services (CMS). These standards not only apply to government insurance reimbursement for retirees, veterans and low income patients, but are recognized by private insurance carriers for all medical procedures.
Is There a Job Out There?
The medical industry is growing by leaps and bounds today, with an annualized billing cycle in the United States that totals in the trillions of dollars. Medical personnel are indispensable and in one of the few inflation/recession-proof fields. It will only get better aging baby boomers require more extensive medical procedures. The newest federal insurance changes will also provide job longevity for a coder/biller who must understand the reimbursement protocols. Medical billers and coders are necessary part of the medical infrastructure. They are the engine that drives everyday medical activities with the dollars that support them. Hospitals, insurance companies and medical billing firms are likely the largest group to seek a coder/biller. Nursing homes are also likely candidates for jobs. It is unlikely that a smaller physician group would hire a biller or coder. This service would likely be farmed out to a billing practice. Contracting with a service saves the practice the cost of individual salaries, insurance and associated benefits.
Is Medical Billing and Coding a Valuable Service? You Bet!
Medical coders/billers keep hospitals, clinics, doctors’ offices and other facilities in total federal compliance. They insure reimbursement and prevent the likelihood of an insurance or government audit. No one in the medical field ever wants to see an insurance examiner or member of the federal Inspector General’s office at the front desk, demanding an audit of the billing department. A false claim, inaccurate code or blatant, fraudulent entry can result in a seizure of assets and medical facility closure.
If you have a knack for numbers and enjoy the challenge of an industry that is constantly evolving, you would be wise to become a medical biller/coder. You also will achieve a great deal of satisfaction in knowing you are an important cog in the wheel of medical progress and the success of whichever facility in which you work.
This article was written by Sebastian Brown.
