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Are Medical Billing and Medical Coding the Same?

Are Medical Billing and Medical Coding the Same?

Medical billing and coding: Just what is it, and what do the specialists in these jobs do each day?

Though they may be found more behind the scenes than physicians and nurses, medical billing and coding specialists are enormously important members of the allied health team. They often work closely together as the liaison between patients, physicians and insurance companies.

Without billing and coding specialists, health care providers would be inaccurately reimbursed for services rendered. These inaccuracies can affect hospitals, doctors, and healthcare providers with finesand even lawsuits. Medical billing and coding specialists are essential to keeping these unnecessary costs at a minimum, and must have an unbelievable eye for detail.

What Does Medical Coding Involve?

What Does Medical Coding Involve?

Anoto AB / Flickr / CC BY-NC-ND

Medical coders work specifically with the financial and technical aspects of the medical world.

They check medical records of patients, along with doctors’ notes, records of testing, and possible diagnoses to corroborate that work was carried out.

Medical codes tell a sort of story about the patient’s visit. Whether a patient was seen for a routine check-up, or a doctor ordered an MRI for a workplace injury, each procedure and service receive a specific code.

The coding specialist must translate this information into precise medical codes for each one of thousands of possible services, which need to be valued for reimbursement purposes.

If the coder is uncertain about a particular patient’s records, they then need to speak with medical staff or other staff members to receive more details.

How Is Medical Billing Different?

Medical billers are expected to audit and submit claims for each patient’s diagnoses and the medical procedures carried out by physicians and nurses.

Using special medical billing software that medical coding specialists have translated and entered into the system, billers communicate directly with patients, medical professionals, and insurers responsible for paying bills. If a clinic or hospital needs authorization from insurance companies to perform procedures, the institution’s medical billing specialists will likely be responsible for calling insurers for guarantee of payment.

It’s also expected that medical billing specialists will be the professionals who follow up on overdue invoices by contacting patients directly, submitting claims with collections agencies and appealing denied claims. They also typically walk patients through information regarding deductibles, copay, and various other requirements from insurance companies.

Where Do Medical Billers and Coders Work?

You can find medical billers and coders in a variety of settings. Typically, they’re found behind the scenes at clinics, hospitals and nursing homes, but they may also find work in pharmacies. With such a wide range of possible employers, it’s a great opportunity to find a career close to home!

Because so much of the work is done with computer systems, many billers and coders are given permission to work from home one or two days a week. Medical billing or coding can be a great choice for those who seek a more flexible working environment.

At a small facility, there’s a good chance that billing and coding will be done by the same person or a close group of associates.

Do I Need Medical Billing and Coding Certification?

Do I Need Medical Billing and Coding Certification?

Army Medicine / Flickr / CC BY

Entry-level medical biller and coder positions demand that applicants have, at minimum, a high school diploma, as well as a corresponding certificate. Receiving the proper education is not only an important aspect of being hired but also gives applicants a leg-up by preparing them to be capable, dependable team members.

Because of the close-knit relationship between medical billing and coding, many medical billing programs offer combined education in both areas in order to give students a deeper understanding and more flexible skill set.

Obtaining Medical Coding and Billing Certification

There are multiple organizations that offer certification exams for healthcare administration, like AHIMA, AAPC, NHA, and NCCT. The American Health Information Management Association (AHIMA) is typically the most recognized for Medical Coding, and–depending on education and experience–there are specialized credentials offered by AHIMA and AAPC, too. Certification through NHA or NCCT, however, would suffice for smaller doctors’ offices and clinics.

What Does the Medical Coding Exam Involve?

Future billing and coding specialists will be expected to memorize hundreds of medical terms and alphanumeric codes related to supplies, drugs, and procedures. Students are expected to understand in-depth information regarding radiology, anesthesia, and pharmaceuticals.

What Do You Learn in Preparatory Programs?

In preparatory programs, future billing and coding specialists will focus on courses like human anatomy, medical coding, insurance billing, HIPAA, and especially how to handle electronic health records. Programs should provide ICD-10 code set training, which is the industry standard for medical classification.

Internships and Externships Are Excellent Opportunities

Look for programs that offer internships or externships. Participating in an internship or externship shows prospective employers that you’re extremely capable and enthusiastic about your future career. It also means that you’ll be able to hit the ground running in a new job, with limited training from your new employer  

Certification exams recommend that applicants have experience and/or a strong foundation of understanding, and internships or externships will give both billers and coders a serious advantage.

What is a Typical Medical Coding and Billing Salary?

In 2015, the median salaries for medical billers and coders were comparable and hovered around $37,000 per year (or nearly $18 per hour). Because of their similar positions, medical billers and coders can typically expect similar pay raises with sufficient work experience, and within five to seven years, can expect to earn upwards of $19-$29 per hour.

As the healthcare industry is constantly adding and redefining new regulations and laws, being adaptive and willing to learn are necessary character traits for upward mobility.

According to Bureau of Labor Statistics, the job market for health information technicians is set to increase by 15% over the next decade, giving professionals in this sector impressive job stability and flexibility.

Consider Medical Billing and Coding Schools in NJ

Whether you’re looking for access to excellent training and certification programs, or access to great working environments, the greater tri-state area offers tremendous benefits for those interested in starting a new career in medical billing and coding.

If you’re interested in learning more about medical billing and coding opportunities, check out this AIMS Education program, and contact us with any questions. We’re looking forward to hearing from you!

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