Medical Billers and Coders (now classified under the rubric of Health Information Technicians) assist healthcare providers and insurance companies to accurately code medical diagnoses and procedures to expedite the filing and payment of insurance claims.
Information collected by medical coders includes patient health history, medical diagnosis, treatment protocol, and prescribed medications. Every diagnosis and medical procedure is assigned an alpha-numeric code using specialized classification software. Medical billing and coding professionals must be familiar with several different coding systems depending on whether the patient is privately insured or billed through Medicare and type of setting where services performed (outpatient or hospital-based).
Step-by-step process guide:
- It is the medical biller and coder’s responsibility to input patient information into the patient database using the appropriate codes to create an insurance claim.
- This claim is then submitted to the appropriate insurance carrier where it will be either accepted or denied.
- If the claim is accepted, the health care provider will reimbursed according to the rates set for the specific code.
- If the claim in denied, the medical biller and coder must follow-up with the insurance carrier to determine the reason. They must then notify the health care provider, update the status of the claim in the database, and send a bill to the patient.
- Medical billers and coders are also responsible for handling collections and working with insurance companies to investigate possible instances of insurance fraud.
According to the U.S. Bureau of Labor Statistics, employment of medical billers and coders is expected grow by about 20 percent through 2018 which is faster than the average for all occupations. Job growth will be due to aging of the population, along with the rise in the number of medical tests and procedures being performed.
Educational and Training Requirements
According to Josh Berndt, Public Relations Officer with the American Academy of Professional Coders (AAPC) there are no mandated educational requirements to begin a career as a medical biller or coder in Texas, ”although it helps to have some courses in anatomy and physiology.” However, there are certain skill sets and knowledge specific to the field that can best be learned through an accredited educational program.
You may earn a 2-year associate degree or 4-year bachelor degree in the field of Medical Billing and Coding. Having an associate’s degree will provide you with a competitive edge over those with only high school diploma in obtaining competitive-wage employment. Earning a bachelor’s degree in the field will almost guarantee that you will obtain a more lucrative position and be eligible for promotional opportunities, such Health Information Services Manger overseeing the work of medical billers and coders. Those already in possession of an associate or bachelor’s degree may earn a certificate in medical billing and coding. Certificate programs are generally three to nine months in length depending on whether you attend on a part or full time basis. Most degree and certificate programs include an externship during which you will gain real-world experience as a medical biller and coder.
Coursework will include the anatomy and physiology, medical terminology, basis office procedures, insurance claims, the use of medical billing software, coding systems and coding terminology.
The two organizations that provide accreditation for medical billing and coding programs are the American Health Information Management Association (AHIMA) and the American Academy of Professional Coders (AAPC).
As per Mr. Berndt of AAPC, most states, Texas included, have no mandated certification requirements to work as a Medical Biller and Coder. However, a 2005 survey by AHIMA showed that over 73% of employers nationwide believe that credentialing is very important for Medical Coding professionals1.
Additional Benefits of Certification:
- Enhance your earning potential
- Eligibility for promotional opportunities and career development
- Receive recognition from your peers as a professional in the field.
You may obtain medical coding certification from either of the following organizations:
- American Health Information Management Association (AHIMA)
- American Academy of Professional Coders (AAPC)
Each organization will award medical coding certification upon successfully passing an extensive five-and-a-half hour examination. To sit for either exam, candidates must possess a high school diploma or GED.
For details on the AHIMA exam, visit: http://www.ahima.org/downloads/pdfs/certification/CCS_Content_Outline.pdf
For details on the AAPC exam, visit http://www.aapc.com/certification/cpc.aspx
The American Health Information Management Association (AHIMA) will confer a Certified Coding Specialist (CCS) credential.
The American Academy of Professional Coders (AAPC) confers the Certified Professional Coder (CPC) credential. Those will less than two years experience will be given the designation CPC-A (Apprentice). Once the apprentice has accumulated two years experience, they must provide two letters of recommendation or one letter and show evidence of 80 hours of continuing education to obtain the full CPC designation: CPC.
Steps to take AHIMA CCS exam:
- Read the Candidate Guide
- Apply for exam
- Register online
- Complete the application
- Submit transcripts and resume
- Pay exam fee ($299 AHIMA member; $399 non-members
- Read authorization test (ATT)
- Schedule exam online
Steps to take the AAPC CPS exam:
- Complete Application
- Submit transcripts and resume
- Pay $300 exam fee – 4 weeks before schedule exam date
- Be a current AAPC member ($70 for students; $125 for regular membership)
- Exam sites are located in Dallas, Fort Worth Houston, and Temple
Medical Billing and Coding Salary Ranges in Texas
Texas provides wonderful opportunities in the medical billing and coding field as it is home to of the most renowned medical centers in the country, such as Baylor Medical Center and Methodist Hospital System based in Houston.
The table below provides the median salaries for Medical Billers and Coders in select cities:*
* Salary.com (April 2011)