How to Become a Medical Biller or Coder
Is a career in medical billing and coding the right choice for you? Discover more about this rapidly expanding field, the educational and certification requirements, and the potential income.
Medical billing and coding professions provide a fulfilling path in healthcare that doesn’t demand the extensive time and expenses of a medical or nursing degree. These professionals manage payments for healthcare providers, insurance companies, and patients. The demand for medical billers and coders has grown alongside the expansion of healthcare services.
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Distinct medical codes reveal the charges for services provided by healthcare providers. Coders keep medical records and claims up to date with the correct codes that depict patient treatments and services.
Medical billers employ these codes to produce and submit claims to patients, insurance companies, and other payers.
This guide delves into the journey to enter the medical billing and coding profession, encompassing educational prerequisites, certification routes, and income prospects.
What Does a Medical Biller Do?
While one person often takes on both medical billing and coding, these are two roles with different skill sets. Medical billers and coders don’t provide direct patient care, but billers are more likely to interact with patients. Effective communication skills are crucial for billers to discuss medical charges with patients, healthcare providers, and insurance carriers.
A medical biller uses specialized software to enter medical codes and file claims with insurance companies or government agencies like Medicare. The biller also issues statements to patients for any uncovered amounts by insurance. A medical biller may also:
– Confirm insurance coverage, pre-authorizations, and referrals
– Rectify statements and payments
– Establish payment plans and collect overdue accounts
– Appeal denied insurance claims
– Have expertise in HMO/PPO, Medicare, and Medicaid coverage
The U.S. Bureau of Labor Statistics (BLS) forecasts a 9% growth in these healthcare professions from 2020 to 2030. This projection reflects the increasing demand for healthcare among older adults and the expansion of insurance coverage across all age groups.
According to the American Association of Professional Coders (AAPC), the average annual salary for medical billers and coders is $54,800. Earnings fluctuate based on the work setting, level of education, certifications, and experience.
What Is a Medical Coder?
Medical coders assign codes to medical terminology, covering treatments, procedures, equipment, and services. These codes are input into billing systems, ensuring healthcare providers receive accurate payments through insurance or directly from patients.
Medical coders play a crucial role in maintaining accurate billing and payments in compliance with regulations. Although coders typically work independently, effective communication with medical billers, physicians, nurses, and administrative staff is essential.
As medical coders function in various healthcare settings, their daily responsibilities may differ, but common duties include:
– Analyzing patient records and clinical reports
– Researching reimbursement and payment data
– Translating medical data into billing codes
– Ensuring federal and state compliance
– Conducting audits for accuracy
Like medical billers, coders can anticipate a growing job market throughout the decade. AAPC reports that uncertified coders earn an average yearly income of $47,200, while certification boosts this to $60,100. Earnings also vary by specialization, educational level, and experience.
Steps to Becoming a Medical Biller or Coder
1. Obtain a high school diploma or equivalent.
Entry-level positions in medical billing and coding can be pursued with a high school diploma or GED certificate. However, certification and advanced training can broaden career opportunities and earning potential. Certificate or diploma programs and associate degrees typically require a high school diploma or equivalent for admission.
2. Enroll in medical billing and/or coding programs.
Diploma programs and associate degrees are the most common educational pathways for medical billing and coding careers. Aspiring professionals can enroll in these programs at vocational and technical schools. These programs typically take a year or less to complete, providing training for national coding certification exams and entry-level positions. Many schools offer online medical billing and coding classes.
Employers often prefer candidates with associate degrees, which require two years of study. An associate degree provides a foundation in general education with a focus on medical terminology, coding, and information technology (IT). Graduates at this level can find opportunities in insurance companies, government positions, and healthcare providers. Many students also transfer their associate degree credits to bachelor’s programs.
3. Pass certification exams.
Healthcare employers generally prefer billers and coders with professional certifications, as these certifications demonstrate mastery of complex billing and government-mandated coding requirements. Certification can open doors to more job opportunities and higher salaries.
4. Find employment.
Many schools offering medical billing and coding training provide career services to help students prepare resumes, practice interview skills, and identify job openings. Job seekers should include internships and relevant work experience in their applications. Individuals can consult AAPC’s information to discover the cities and states with the best job opportunities and highest salaries.
Medical Billing and Coding Certification
Diploma programs and associate degrees equip students for entry into the field and for professional certification exams. Most students pursue either the certified professional biller (CPB) or the certified professional coder (CPC) credentials. While these are separate certifications, many programs offer dual certifications as CPBs and CPCs.
Overview of Medical Billing Programs
Medical billing and coding programs provide a comprehensive curriculum covering essential subjects like medical terminology, medical ethics and law, and anatomy and physiology. In addition to these common topics, medical billing coursework includes the following:
– Healthcare communications
– Records management
– Computer applications for billing
– Health insurance and reimbursement
Certification in Medical Billing
While professional certification is not mandatory for medical billers, it can enhance job prospects and potential earnings.
1. Certified Professional Biller (CPB): Offered by AAPC, the CPB certification is widely recognized. It attests that medical billers have mastered the skills required to manage healthcare providers’ revenue cycles. The CPB exam consists of 200 multiple-choice questions focusing on billing practices, managed care, Medicare and Medicaid, and HIPAA compliance.
2. Certified Billing and Coding Specialist (CBCS): Administered by the National Healthcareer Association, the CBCS certification centers on medical billing and coding for insurance claims. The 100-question exam covers the revenue cycle, compliance, insurance eligibility, coding guidelines, and reimbursement.
Medical Coding Program Overview
Medical Coding Curriculum
Most medical coding programs offer instruction in medical terminology, coding classifications, HIPAA compliance, and Medicare and Medicaid policies. While specific course requirements can vary by school, typical classes for medical coding students encompass:
– Diagnostic and procedural coding
– Billing and coding applications
– International diseases classification
– Current terminology coding
Certification in Medical Coding
Two of the most widely recognized medical coding certifications are provided by AAPC and the American Health Information Management Association (AHIMA). These certifications include:
1. Certified Professional Coder (CPC): AAPC administers the popular CPC credential, which signifies proficiency in all standard code sets, guideline and management principles. The multiple-choice exam covers 17 areas, including the proper procedures for supplying diagnosis codes used by healthcare providers.
2. Certified Coding Assistant (CCA): The CCA certification from AHIMA covers six domains: clinical classical systems, reimbursement methodologies, health records and data content, compliance, IT, and confidentiality and privacy.
3. Certified Coding Specialist (CCS): This AHIMA certification indicates expertise in coding skills and documentation, provider queries, and compliance. The CCS exam includes multiple-choice questions and a medical scenario section.
Medical coders can also pursue specialized certifications from AAPC, including auditing, documentation, risk adjustment, and physician practice management. Experienced coders can obtain certifications in specific medical disciplines, such as anesthesiology and pain management, orthopedic surgery, and plastic and reconstructive surgery.
Working in Medical Billing and Coding
According to the Bureau of Labor Statistics (BLS), employment opportunities for medical records and health information specialists are expected to grow by 9% from 2020 to 2030, which is slightly faster than the average rate. Most of these jobs can be found in various settings, including:
Hospitals: Hospitals are the largest employers of medical records and health information specialists, accounting for 37% of the workforce in this field. Medical billers and coders assist in managing revenue cycles within hospitals, ensuring accurate and up-to-date revenue data to receive insurance reimbursements and patient payments promptly.
Physicians’ Offices: Doctor’s offices rely on dependable medical coding and billing services. While larger clinics may offer higher salaries, smaller offices can provide a less stressful environment with lower caseloads. Smaller practices often hire individuals who can handle both billing and coding responsibilities.
Administrative and Support Services: Many healthcare providers, government agencies, and insurance carriers depend on medical billers and coders in administrative and support roles. They design and execute procedures to enhance efficiency and profitability. In larger healthcare facilities, IT specialists and consultants are hired to streamline coding and billing work. In smaller settings, administrative assistants with coding and billing expertise handle patient inquiries and process claims. At insurance agencies, these professionals verify claims and work with patients to gather information and explain benefits.
Professional, Scientific, and Technical Services: This category encompasses colleges, law offices, insurance agencies, and IT companies. Colleges and technical schools hire experienced medical coders to educate future professionals. Law offices employ coding and billing specialists to investigate fraud claims. As the use of electronic health records becomes more common, IT departments will employ more medical billing and coding experts to develop, improve, and modify coding and billing systems. Government agencies also hire medical billers and coders to work on research projects, collecting and analyzing medical data for population health studies and healthcare policy reform.
Management of Companies and Enterprises: Medical billers and coders can explore leadership opportunities in roles like auditors, administrators, operations managers, and trainers. They often work in insurance, private healthcare systems, and accounting and payroll services.
Frequently Asked Questions about Medical Billing and Coding
1. How long does it take to become a medical billing and coding specialist?
– Individuals can enter entry-level medical billing and coding careers with a high school diploma or GED certificate. However, advanced training can improve job prospects. Diploma programs typically take one year or less, while associate degrees require two years. Meeting certification requirements may add more time before finding employment.
2. How can I become a medical coder quickly?
– Medical billing and coding programs offered by vocational or technical schools provide the fastest route to employment. Some programs can be completed in six months or less, depending on the specialty and whether you enroll full-time or part-time.
3. How much does a medical coder earn per hour?
– According to AAPC, Washington, D.C., offers the highest average hourly wage at $34.06, while Mississippi has the lowest at $22.24.
4. Is medical coding a stressful job?
– The level of stress experienced by medical billers and coders can vary based on their work environment. Those working in smaller clinics and medical practices may experience less pressure than those employed by larger healthcare providers and insurance companies. Remote billers and coders report less stress and greater job satisfaction.
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