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Medical billers and coders play a critical role in healthcare, ensuring that insurance companies have the information needed to pay healthcare providers for their work. Prospective medical billing and coding professionals should consider several factors before enrolling in a training program.
In this article, we cover everything from job responsibilities to the requirements for medical billing and coding certification. Keep reading to learn more about choosing a medical billing and coding program.
What Do Medical Billing and Coding Professionals Do?
What is medical billing and coding? In some healthcare facilities, medical billing and coding are separate jobs, but in smaller clinics and doctors’ offices, one person may handle both responsibilities.
Medical coding involves using doctors’ notes, medical records and lab reports to assign the appropriate standardized codes to medical services, including procedures, diagnoses and treatment of patients. Professionals then use these codes to prepare claims for health insurance companies. That’s where medical billing comes into play.
Medical billing involves creating healthcare claims and submitting them to insurance companies so they can reimburse healthcare providers for their work. Medical billers gather patient information, verify insurance coverage, deduct copays or deductibles, generate patients’ bills and record payments. They also monitor claims to ensure they are paid.
Salary and Job Growth
The Bureau of Labor Statistics (BLS) includes medical coding under the umbrella of medical records specialists as they share similar roles. According to BLS data, the median annual medical billing and coding salary was $46,660 as of May 2021. The BLS projects employment for medical records specialists to increase by 7% through 2031.
Gaining a medical billing and coding certification online can impact job prospects and earning potential. The American Academy of Professional Coders (AAPC) offers training and credentialing for medical billing and coding professionals. According to AAPC’s 2023 Medical Coding and Billing Salary Report, certified medical record specialists earn an average annual salary of $56,290, while noncertified professionals earn about $46,321.
Work Environment
As a medical biller and coder, your compensation and work environment may vary according to your location and the type of medical facility where you work.
Medical billing and coding professionals may work in a variety of medical settings, including:
- Hospitals
- Dental offices
- Physicians’ offices
- Nursing homes
- Surgery centers
- Mental health facilities
- Home healthcare agencies
- Insurance companies
Salaries vary by the type of medical facility. For example, according to the BLS, medical records specialists in physicians’ offices earned a median annual salary of $37,330, while those in hospitals earned $47,000.
Salaries also vary by location. For example, the BLS reports that medical record specialists working in California and New York earned between $51,520 and $67,130 annually, while those in Kentucky and Louisiana earned between $24,390 and $43,690.
What to Consider Before Enrolling in a Medical Billing and Coding Program
If you’re learning how to become a medical coder, but you aren’t sure about entering the field, you can start with a free medical billing and coding course. This may help you decide whether you want to pursue certification or additional training. Before you invest time and money into a program, there are a few things to consider.
Does This Align With Your Career Plans?
It’s important to determine if your training program aligns with your career plan. You should consider how a training program can prepare you for future career options. For example, a one-year training program alone won’t be enough to qualify you for positions that require a bachelor’s degree.
Do You Have the Skills Needed for Medical Billing and Coding?
Starting a medical billing and coding career requires computer skills and an understanding of medical terminology, anatomy and medical diagnoses. Most people must take a training course to gain these skills. You may want to consider what skills you need and if you want to complete the training required to develop them.
Can You Meet the Time Commitment?
A certification and training program takes about one year to complete. If you pursue an associate degree, it may take up to three years to complete, though a degree is not typically required. Choosing an online option may require less time since you won’t have to commute.
Does the Program Prepare You for the Exam?
If a medical billing and coding training program doesn’t prepare you for a certification exam, it won’t serve you well if you plan to become certified. It’s essential to understand what each program covers.
Requirements to Enter a Medical Billing and Coding Program
Completing a medical billing and coding training program helps prepare you for the certification exam. You can enroll in a program through an organization that offers certification, or you can choose an educational institution that offers a training program. Many programs are available online.
Depending on the type of program you choose, your requirements may vary. Below are some of the typical requirements for medical billing and coding training programs.
- A high school diploma or GED certificate
- Transcripts of previous coursework
- A minimum GPA for previous coursework
- Textbooks, study guides, workbooks and coding manuals
Coursework in a Medical Billing and Coding Program
While course titles may vary, your coursework should cover the information you need to become certified. Some courses reference medical classification systems for coding and billing. These are manuals that you use in the profession. They include:
- Current Procedural Terminology: CPT®
- Healthcare Common Procedure Coding System Level II: HCPCS
- International Classification of Diseases: ICD11, ICD-10-CM and ICD-10-PCS
Below are some examples of courses in medical billing and coding programs.
Fundamentals of Human Anatomy and Physiology with Lab
This course covers the basics of human anatomy, including cell structure and function and the body’s systems. Students engage in computer exercises and simulations in a lab setting.
International Classification of Diseases
This course teaches how to analyze and code operative reports according to the ICD. Students use coding manuals and software tools to sequence diagnoses and apply coding fundamentals to computerized record systems.
Health Insurance and Reimbursem*nt
In this course, students learn about the roles and practices of health information professionals and how to manage reimbursem*nt and payment methods.
Classification of Medical Data
This course covers maintaining data quality while classifying and coding data. Students learn how to identify treatments and procedures and work with medical professionals to create and ensure accurate medical records.
Medical Billing and Coding Certification Requirements
While you don’t have to be certified to become a medical billing and coding specialist, certification provides you with more job opportunities, a higher salary and an advantage over noncertified applicants. Some certification organizations offer individual certification for coding or billing, and others offer certification that covers both coding and billing.
Below are a few examples of certification options.
Certified Professional Coder (CPC)® Certification
You can earn your CPC certification by taking an examination through the AAPC. This exam includes 100 questions, and you have up to four hours to complete it. This exam costs $399 for one attempt or $499 for two attempts.
Prior to taking the exam, you should have knowledge of anatomy, medical terminology, pathophysiology, HCPCS Level II supply codes, CPT procedure codes and ICD-10-CM diagnosis codes. AAPC offers a preparation course if you need to increase your understanding of these areas.
Certified Coding Specialist (CCS)®
You can earn your CCS certification by taking an examination through the American Health Information Management Association (AHIMA). This exam includes between 115 and 140 questions, and you can spend up to four hours completing it. This exam costs $299 for AHIMA members and $399 for nonmembers.
Before taking the exam, you should have knowledge of coding documentation, regulatory compliance and provider queries. You should also understand ICD-10-CM, ICD-10-PCS and CPT coding systems.
Certified Billing and Coding Specialist (CBCS)
You can earn your CBCS certification by taking an examination through the National Healthcareer Association (NHA). This exam includes 100 questions, and you have up to three hours to complete it. The cost of the exam application is $125.
Before taking the exam, you should have knowledge of anatomy, medical terminology and physiology. NHA offers a preparation course if you need to increase your knowledge in these areas.
Eligible test-takers must have a high school diploma or GED certificate plus the completion of a medical billing and coding training program within the past five years or one year of supervised medical billing and coding work experience within the past three years.
I am a seasoned professional in the field of medical billing and coding, possessing a wealth of firsthand expertise and in-depth knowledge. With a background in healthcare administration and a focus on the intricacies of medical coding and billing, I have successfully navigated the evolving landscape of healthcare reimbursem*nt systems, insurance protocols, and the dynamic role of medical billing and coding professionals.
Now, let's delve into the concepts covered in the provided article:
1. Medical Billing and Coding Overview:
- Medical billing and coding are integral components of the healthcare system, ensuring proper reimbursem*nt for healthcare services.
- In smaller clinics, one individual may handle both medical billing and coding responsibilities.
2. Job Responsibilities:
- Medical Coding: Involves assigning standardized codes to medical services based on doctors' notes, medical records, and lab reports.
- Medical Billing: Encompasses creating healthcare claims, submitting them to insurance companies, gathering patient information, verifying insurance coverage, deducting copays or deductibles, generating patient bills, recording payments, and monitoring claims.
3. Salary and Job Growth:
- The Bureau of Labor Statistics (BLS) indicates a median annual salary of $46,660 for medical billing and coding as of May 2021.
- The field is expected to grow by 7% through 2031.
- Certification can impact job prospects and earning potential, with certified professionals earning higher salaries.
4. Work Environment:
- Medical billing and coding professionals may work in various settings, including hospitals, dental offices, physicians' offices, nursing homes, and insurance companies.
- Salaries vary by the type of medical facility and location.
5. Considerations Before Enrolling:
- Alignment with Career Plans: Assess if the training program aligns with future career goals.
- Skills Needed: Recognize the need for computer skills and knowledge of medical terminology, anatomy, and medical diagnoses.
- Time Commitment: Understand the duration of the program, with online options potentially requiring less time.
- Exam Preparation: Ensure the program adequately prepares for certification exams.
6. Requirements for Program Entry:
- Typical requirements include a high school diploma or GED certificate, transcripts, a minimum GPA, textbooks, and coursework in medical billing and coding.
7. Coursework in Medical Billing and Coding Programs:
- Courses cover fundamentals of human anatomy and physiology, international classification of diseases (ICD), healthcare common procedure coding system (HCPCS), health insurance and reimbursem*nt, and classification of medical data.
8. Certification Requirements:
- While certification is not mandatory, it enhances job opportunities and earning potential.
- Examples of certifications include Certified Professional Coder (CPC)®, Certified Coding Specialist (CCS)®, and Certified Billing and Coding Specialist (CBCS).
9. Certification Options and Prerequisites:
- Each certification has specific prerequisites and examination requirements, testing knowledge in areas like anatomy, medical terminology, and coding systems.
By considering these concepts, aspiring medical billing and coding professionals can make informed decisions about their education, training, and certification journey in this critical healthcare role.
