Medical Billing & Coding Schools Schools, Program Info and Expert Advice on Medical Billing & Coding
Most people see a doctor and give no further thought to the people who
do the paperwork. But medical billers and coders, with their eye for detail
and knack for detective work, play an important behind-the-scenes role in
keeping patient records current and accurate, and bridging the gap between clinical care and administration. As the field becomes more specialized, schools are responding with programs targeted to serve changing industry demands. Take a look at what’s involved with careers in medical billing and coding, explore different programs, and get an expert’s take on the field.
Medical Billing & Coding Learning Center
Getting started in a career in medical billing or coding doesn’t have to be difficult, but it helps to know more about what it entails – from education requirements to salary expectations – before making a commitment. Learn more here about what to expect in a training program and on the job.
General and specialty certifications in billing and coding, and their impact on career opportunities.
The regions and industries with demand for medical billers and coders, and salary information.
Training options for medical billing and coding, including for hospitals, private practices or specialty tracks.
Online vs On-Campus Learning Opportunities
Students who attend a community college may still have an option to take credits either on-campus, online, or some combination of both. Neither format is inherently better. While in the past online schooling was sometimes considered inferior, efforts have been made to make it as rigorous as traditional education. Students should examine their own study style and other obligations, and make the choice from there. Below we take a look at some of the characteristics of each format:
It can be difficult to commit to being a full- or even part-time student, but online options allow students to work within their own schedules and at their own pace.
Students in online programs can often complete training while holding down a job to help pay for their schooling. Even if students choose to devote their time entirely to coursework, online programs are generally less expensive than those taken on-site at a college.
Students are not limited by their proximity to a college to take on virtual learning. Medical billing and coding students in online programs have access to professors and experts around the world.
With lectures, video tutorials, hands-on work, hard-copy and digital textbooks, and the opportunity to email instructors with questions, online students can engage with material in many different ways.
Structured learning environment
Students learn the material within a specific time frame outlined by instructors. Tests and projects are completed, evaluated, and discussed in a structured setting that can benefit those who respond well to outside motivators.
Interaction with professionals
Being able to talk to an instructor face-to-face can be valuable, especially for students who are struggling with a particular area or need a little extra help. Students taking credits on-campus have more informal chances to approach professors to discuss problems or ideas.
Interaction with peers
The chance to speak with fellow students exposes on-campus learners to new points of view and engages them in a community of their peers.
Approved outside learning opportunities
Many colleges offer internships or other outside learning opportunities, and professors can connect students with reputable places to gain work experience. Also, working in a local environment gives students the chance to compare experiences with their peers.
Medical Billing & Coding Basics
Medical billing and coding careers serve to connect the clinical and business aspects of healthcare. Due in large part to factors such as aging baby boomers and federal legislation that has increased access to healthcare, the U.S. healthcare sector continues to grow. As it does, hospitals, doctors’ offices and other healthcare facilities are turning to medical billers and coders to handle specialized administrative duties. Although the job responsibilities of each can overlap – especially in smaller settings – each plays a specific role in the workplace. Here’s how the process typically works:
Patients see a physician or undergo treatment, anything from a simple annual checkup to a complex surgery.
Medical coders review diagnoses, test results, procedures, and other information, and assign them the corresponding medical codes.
Medical billers enter coded information onto bills in the proper order and form, and then submit them to insurance companies or individual clients for payment.
Insurance companies review the categorization of procedures or treatments, and reimburse providers according to the terms of the coverage plan.
Medical Billing & Coding Skills
After narrowing down their degree options, students should make sure that their programs of choice meet the following criteria:
While medical billers will be familiar with some medical codes and the process used to determine them, their primary function is to make sure that coding information is properly presented, that bills are correctly calculated and formatted, and to follow up and work with clients or insurance companies as necessary. Key skills in this role include:
Medical billers may deal with any number of types of people in a day – from providers to patients to insurance representatives – and must speak the language of all of them. They should be comfortable with the shorthand and terminology of professionals, while being able to translate it into more accessible language for laypeople. They must also be able to clearly document diagnoses, procedures and treatments in written form.
Financial and data analysis skills
Healthcare can be expensive, and when procedures are not correctly documented or billed, it can potentially cost a practice thousands of dollars. Billers need a thorough understanding of how the finances of a physicians’ office or medical facility are structured, as well as how insurance companies’ reimbursement policies work, in order to maximize returns.
Ability to work as part of a team
Medical billers serve as liaisons between physicians, patients and insurance companies, and also work closely with medical coders and other administrative staff. Those who are cooperative, proactive, and solution-oriented usually get the best results.
Understanding of Insurance
Insurance policies can be complex, and medical billers need a thorough understanding of how benefits are typically structured and what exceptions may apply. This helps them to correctly submit bills to insurance to ensure timely payment. They should also know how to read and interpret Explanation of Benefits (EOB) forms issued by insurance companies.
The jobs of medical coders dovetail with those of medical billers, although in general, coders tend to work more independently. While specific duties can vary depending on whether they work in a small private practice or a large hospital system, professionals in the field share several of the same key skills:
Attention to detail
Tens of thousands of different codes comprise the ICD-10 system recently implemented in the U.S. It’s important to be familiar not only with these categories of codes and their key differences, but also with interpreting patient information in order to select the corresponding codes.
Choosing the correct codes for a patient’s records is not always easy or straightforward. Good coders are skilled at doing the necessary research about conditions, terms or treatments to get accurate information and make decisions accordingly.
Knowledge of medical terminology
Complex medical terms are the everyday vocabulary of medical coders. They have a comprehensive knowledge of the language used to describe human anatomy, physiology, pathology and pharmacology, and can then translate medical conditions and treatments into the codes needed for record-keeping and billing.
Coders may have numerous cases to deal with at any one time, so they must be good at organizing their time, setting priorities, and juggling multiple tasks.
Ability to maintain confidentiality
Because medical coders are privy to individuals’ personal health records and data, they have a responsibility to familiarize themselves with privacy laws that protect patients, as well as with ethical considerations in handling sensitive medical information.
Expert Advice from a Professional Medical Coder
Medical coder and auditor Richelle Marting shares her insights into the field.
What are key qualities needed to be successful as a medical coder?
Things that come to mind are being detail-oriented and inquisitive. Medical coding is such an investigative process. It can be really interesting if you have this natural curiosity to learn the anatomy of the things that you’re coding, and if you’ve got the interest to do the research and find a solid authoritative source to support the decisions you’re making as a coder.
What should prospective students consider when looking for a program?
They should consider what their end goal is. Different programs have different focuses. Some are focused on hospital in-patient settings, and others are focused on physicians’ offices. Of course you can cross over, but it’s helpful to know where you want to work.
Can you describe a typical career for a coder?
The traditional coding position is desk work, but there are infinite possibilities to what a professional coder could do. They could also work as a quality reviewer, an internal or external auditor, a consultant to other medical professionals, or an educator. Many positions could involve travel or leading meetings. Also, I’ve seen a trend in coders wanting to work from home, so a lot of hospitals and health systems are starting to move coding positions to a remote work setting.
How important is it to have a specialty?
There is such a need for good coders in specialty areas such as neurosurgery, orthopedics, or gastroenterology. You can have a broad coding basis and do well, but if you are a specialty coder who really knows the anatomy, terminology, medications, codes, and rules that revolve around your specialty, there’s a very high demand.