Medical billing and coding is a fast growing career of choice for those who are keen to succeed in the field of allied health care services.
But it is not as same as other jobs in the field of healthcare. It is essentially a backend function that ensures the entire healthcare system operates in an organized, effective and productive manner.
It is the duty of the medical billing and coding specialist to process patient data and related information including treatment details and insurance information.
If the medical office does not function to its full potential then it will be difficult for health care providers to bill patients accurately, take payments on time, follow up with insurance companies for claims, or even keep a track on costs and expenses. In other words the entire system will come to a grinding halt!
In most healthcare facilities the biller and the coder may be one and the same person. But their duties and functions are not exactly the same.
Read on to find out more about this exciting field.
What Do Medical Billing and Coding Specialists Do?
Medical billing and coding specialists are responsible for the business side of healthcare services.
The coders record all the health care services provided to a patient from the beginning to the end of a treatment process. There are unique and different codes for every symptom, medication and diagnosis.
The entire medical history of the patient is recorded in a series of formal codes which also guarantee the privacy and confidentiality of patient data.
Medical billing and coding specialists need to have comprehensive knowledge of medical terms and terminology, human anatomy and coding practices. A medical coder performs critical tasks and hence need to be well-trained and educated on all aspects of his or her job.
Billing specialists generate invoices from the coded patient data for the use of patients or the insurance agencies as the case may be. They are responsible for tracking unpaid invoices and ensure payments are made as soon as possible.
Billing specialists are the nerve centers of all business activities taking place in in hospitals and clinics. They have to communicate with insurance companies, physicians and clients on a regular basis.
Medical billing and coding specialists work hand-in-hand to ensure payments are on time and there are no discrepancies in invoices. In cases where the invoices are rejected they will have to audit the invoices and make changes wherever necessary. The invoices will have to be re-filed and tracked to ensure timely payment.
What Are the Job Responsibilities of a Medical Billing and Coding Specialist?
There are two roles that a medical billing and coding specialist accomplishes- that of a coding specialist and that of a billing specialist. And there are separate set of responsibilities for both the roles.
Coding specialists will have to interpret patient data from medical charts and allocate relevant codes for all the medical services provided to individual patients.
Coders develop a detailed understanding of various medical procedures and of the cases commonly dealt with in their specific health facilities or clinics. A majority of cases will be fairly simple and straightforward with no complications, which will make a coder’s job easy.
But sometimes complex and confusing cases will come up where proper coding will prove to be a challenge, and will be difficult to accomplish. There are also confusing gray areas in coding guidelines and practices which might further slowdown a coder’s job.
In these situations you will have to rely on experience and judgment. You will have to consult specialists and physicians, be active on online forums and widen your knowledge through peer-to-peer interaction and have access to quality and updated industry journals and resources.
A medical billing and coding specialist’s job is a critical one and very often invoices and claims will get rejected. You will have to go through all the details and re-file claims successfully.
There are regular audits in big hospitals and healthcare facilities on coding and documentation accuracy. You will have to adhere to all protocols and compliance procedures to ensure favorable results.
Billing specialists need to be familiar with the coding practice, standards and terms. They should be able to read bills and invoices accurately and follow up with insurance agencies for timely payment.
In many cases invoices are submitted to patients as well. The billers will have to explain the details to the patients or their families. Sometimes the families may be stresses or worried, so the biller has the additional responsibility to ensure that there are no misunderstandings and all formalities are completed smoothly.
You will also have to track unpaid invoices and ensure they are paid on time.
A medical billing and coding specialist also needs to be aware of the various health plans and programs, and the different rules and criteria governing them.
What Are the Career Prospects for a Medical Billing and Coding Specialist?
As per the Bureau of Labor Statistics report, the demand for medical records and health information technicians (including billers and coders) is expected to grow by about 21% through 2010 to 2020. The median annual wage for this sector was $34, 160 in May 2012.
With increasing demand for healthcare services, more backend professionals are required to ensure the business side of facilities functions properly.
With proper training it will not be difficult for qualified professionals to gain meaningful employment with good remuneration.
What Are the Qualifications and Certification Requirements?
On-the-job training used to be the norm of the past. But with increasingly complex processing cycles and stringent regulatory requirements, formal training has become essential to gain employment with reputed employers.
Professional training will ensure you are well-versed with the latest billing and coding standards. You will also gain familiarity with the latest manual and computer aided billing and coding processes.
Formal classroom training also helps you understand the legal implication of your job, and the ethical and moral responsibilities.
There are no formal certification requirements but Certified Medical Reimbursement Specialist (CMRS), Certified Billing & Coding Specialist (CBCS), and Certified Professional Coder (CPC) certifications are preferred by many students and employers.
With comprehensive training you will be able to clear these exams comfortably.
The medical billing and coding profession is full of scope and potential. Make the right choice now and you have a very rewarding career ahead of you.