Standing tall and mighty at $2.9 trillion, the American healthcare industry is accelerating towards new heights by targeting improved research and medical facilities. Fed by heavy investments and the invention of new compounds and drugs, the industry is also creating several opportunities for healthcare professionals to meet the rising demand for healthcare. Healthcare professionals and technicians make one of the largest occupational groups in America, having withstood the recession and other financial and political challenges.
It is, therefore, a sprouting industry to pursue a career in. The demand for medical assistants, pharmacy technicians, and medical billing and coding specialists is on the rise owing to the emergence of new medical establishments and increased healthcare requirements.
Improved digitization of systems, new insurance policies, changes in insurance billing process, sharing of patient records, etc. have all brought the focus on health informatics.
The U.S. Bureau of Labor Statistics predicts a 22% rise in the jobs for certified medical billing and coding specialists by the year 2022. Medical billing and coding specialists form an integral part of the healthcare system, ensuring that healthcare providers always receive the correct remuneration for the services they provide.
What Do Medical Billing and Medical Coding Specialists Do?
Medical billing and coding is the process of translating all the relevant patient information into universal numeric or alphanumeric codes. Right from patient visits, symptoms, tests performed, to diagnosis – all the information is coded using ICD (International Classification of Diseases) or CPT (Current Procedural Terminologies) codes. While medical coding and medical billing are separate fields, employers often prefer hiring specialists with proficiency in both.
Medical billing facilitates payments to healthcare service providers for the services they offer. While the codes help to track the spread of diseases and the effectiveness of a procedure, their main purpose is to aid the reimbursement process.
Billing is carried out to process payments between three parties: the patient, the healthcare service provider (doctor, clinic, hospital, medical facility, etc), and the insurance company (payer). The medical billing associate negotiates and arranges for payment between these three parties.
The billing professional collates all the information related to a patient and his/her medical procedure, and uses it to produce the bill, otherwise called the claim, for the insurance company. In addition to the insurance coverage information, the claim also contains the patient’s medical history and the list of procedures that were performed as a part of the treatment for the patient. The billing associate is responsible for interpreting the patient’s insurance plan and creating a claim accordingly. The procedure (CPT) and the diagnosis codes (ICD) used by the medical coder are referred upon by the medical billing associate to create the claim.
This claim is used by the insurance company to determine the amount to be reimbursed to the healthcare service provider. Finally, the balance amount is sent to the patient by the billing associate to complete the payment cycle. An associate’s responsibility is to consistently communicate with the payer and the patient to ensure quick payment to the provider.
Medical coding requires one to be aware of thousands of codes assigned to symptoms, medications, and diagnosis. Hence, it becomes crucial for an aspirant to avail professional training in order to perform successfully on the job. With diseases and symptoms increasing in complexity, the amount of data needed to be sent to the insurance company also increases. This is where medical coding comes into the picture. Coding allows the efficient transfer of enormous amounts of data across medical facilities. Uniform coding enables easy interpretation of medical reports, diseases, and procedures performed by doctors across cities.
Coding also simplifies the process of collecting data and taking surveys and statistics for several diseases; an activity carried out by governments and health agencies to analyze healthcare-related issues and to maintain records.
During medical coding training, a medical coder learns to use the following codes to create accurate medical reports:
International Classification of Diseases – ICD codes were created by the WHO to maintain uniform vocabulary for injuries, symptoms, and diseases. These codes are used to represent the patient’s condition and the corresponding diagnosis performed by the doctor.
Current Procedure Terminology – Published and maintained by the AMA (American Medical Association), CPT codes are used to depict the medical procedures performed by a doctor or any other healthcare service provider.
Healthcare Common Procedure Coding System – HCPCS is a set of codes based on CPT codes. These codes are used to represent procedures, services, and equipments that are not covered by the CPT codes.
It is extremely crucial for the medical coding specialist to identify and enter the accurate codes in the medical report. Any misrepresentation of the codes can lead to serious administrative and health complications which could, at times, be irreversible.
Medical Billing and Coding Certification
Medical Billing and Coding Certifications are highly-valued as they provide assurance of knowledge validation and stand for best-in-class education and training.
In order to become a valued medical billing and coding specialist, a candidate can avail medical billing and coding training from recognized organizations and proceed towards pursuing the certification from the following recognized organizations:
American Academy of Professional Coders (AAPC) – AAPC offers Certified Professional Coder (CPC) examination and certification which is a gold standard for medical coding. Upon completion of the CPC certification, a candidate becomes eligible to apply for AHIMA and NHA certification examinations.
American Health Information Management Association (AHIMA) – Candidates can increase their market value by demonstrating exceptional coding competencies by achieving the Certified Coding Associate (CCA) credential offered by AHIMA.
National HealthCareer Association (NHA) – NHA offers Certified Billing and Coding Specialist (CBCS) exam and certification, thereby helping aspiring candidates gain extensive knowledge to become the most-sought-after billing and coding specialists. Skills acquired through this certification are valued greatly by physicians, hospitals, healthcare facilities, and insurance companies.
Sound knowledge of medical billing and coding guidelines is sure to foster effective growth for medical billing and coding professionals, thereby helping them perform vital roles in healthcare establishments. Due to the increasing demand, this profession offers job security and increased employment opportunities, especially for the certified specialists.