Medical Billing and Coding Programs

What is a medical billing and coding specialist?

Medical billing and coders, more commonly referred to as health information technicians, organize and manage health information data in both paper and electronic systems. A medical coder will use various classification systems to code and categorize patient information for insurance reimbursement purposes, for databases and registries, and to maintain patients’ medical and treatment histories. Per O*Net, typical job titles for someone in this position are greatly varied and would include:

  • Coder
  • Health Information Clerk
  • Health Information Specialist
  • Health Information Technician (Health Information Tech)
  • Medical Records Analyst
  • Medical Records Clerk
  • Medical Records Coordinator
  • Medical Records Director
  • Medical Records Technician (Medical Records Tech)
  • Registered Health Information Technician (RHIT)

Why pursue a medical billing and coding career?

According to the Bureau of Labor Statistics (BLS), the field of health information (which includes medical coding and billing programs) is expected to increase in size by 8% by the year 2029 (this is much faster than average growth). Why is this you might ask? Well the American health landscape is changing and demand for healthcare is growing! Also provided by the BLS, here are some interesting facts about the growth of the healthcare industry:

  • As of 2015, 11.8 million people were employed in healthcare occupations.
  • Hospitals employed 3.8 million healthcare workers.
  • Almost 82% of healthcare roles were in the healthcare and social assistance industry.
  • The number of Americans 65 and older continues to grow each year. The 2010 US census indicates that the 65+ population is at its highest peak ever at 40.3 million people, an increase of 5.3 million in just 10 short years. That is 13% of the total US population!
  • The number of US doctor office visits in 2015 was nearly 1 BILLION

In addition, according to the BLS, the May 2020 median annual health information technician or medical billing and coding salary was $44,090. As per the BLS, states with the highest employment levels within this occupation are: California, Texas, Florida, Ohio and New York.

What are important qualities or skills for a medical coder to have?

  • Critical Thinking: A medical coder should understand how to follow medical records and diagnoses and then decide how to best code them in the medical records
  • Detail Oriented: When it comes to medical diagnoses and coding those diagnoses it is extremely important that a medical coder is accurate when recording the information
  • Personable: A medical coder works with various groups of people, from patients to doctors to finance personnel, as a result, being able to effective communicate with others would be an important skill to have
  • Tech Savvy: A medical coder must be able to use coding and classification software and the EHR system their place of employment uses.

What type of job responsibilities do medical billing and coders typically have?

Medical billing and coding professions may perform a variety of tasks while working such as:

  • Organize and maintain data for clinical databases and registries
  • Review patient information for preexisting conditions such as diabetes
  • Retrieve patient records for medical personnel
  • Work as a liaison between the health clinician and billing offices
  • Use classification software to assign clinical codes for reimbursement and data analysis
  • Electronically record data for collection, storage, analysis, retrieval, and reporting
  • Protect patients’ health information for confidentiality

Where do medical billing and coding specialist work?

Medical billing and coding professionals generally work in a doctors’ office or in a hospital.  Per the BLS, the industries that employed the most health information technicians in 2019 were as follows:

  • Hospitals (state, local, and private): 37%
  • Offices of physicians: 15%
  • Administrative and support services: 5%
  • Professional, scientific, and technical services: 5%
  • Management of companies and enterprises: 4%

Medical Billing and Coding Programs

According to the Bureau of Labor Statistics, health information technicians, which includes medical billing and coding, need a postsecondary certificate to enter the field, although some may also pursue an associate’s degree. In addition, many employers prefer hiring professionals who have finished postsecondary training in their field or that have a professional certification.

In order to get certification, many professionals take a variety of medical billing and coding classes similar to these courses listed below – many programs also include hands-on experience:

  • Medical Terminology for Healthcare Professionals
  • Diagnosis & Procedure Coding
  • Pharmacology
  • Computer Software Applications in Healthcare
  • Insurance Claims, Processing and Adjudication
  • Ethics and Health Information Management

Medical Billing and Coding Certification

It is important to understand that completing a post secondary certification program is not the same thing as becoming professionally certified, though a certification program may help you pass the exam to become professionally certified!. Certifications are earned from a professional society and, in general, must be renewed periodically. There are many options for professional certification which include:

  • Certified Professional Coder (CPC)  issued by the American Academy of Professional Coders (AAPC) – held by over 105,000 coding professionals
    • 150 multiple choice questions (proctored) – Open code book
    • 5 hours and 40 minutes to finish the exam
    • One free retake
    • Cost: $325, Also requires annul $125 membership to AAPC
    • Every two years you will be required to complete 36 continuing education units (CEUs)
  • The Certified Professional Biller (CPB) issued by the American Academy of Professional Coders (AAPC)
    • 200 multiple choice questions (proctored) – Open code book
    • 5 hours and 40 minutes to finish the exam
    • 1 free retake to be used within one year of first of attempt
    • Cost: $325, Also requires annul $125 membership to AAPC
    • Every two years you will be required to compete 36 CEUs
  • Certified Medical Reimbursement Specialist (CMRS) offered through the American Medical Billing Association (AMBA).
    • 763 questions
    • Exam is taken online and is open book, with 45 days to complete the exam
    • Two free retakes are allowed with a mandatory 30 day waiting period between retakes (but not more than 60 days)
    • Cost: $325, Also requires annual $99 membership to AMBA
    • Each year, you will be required to submit 15 CEUs in order to extend your credential for another year
  • The Certified Coding Assistant (CCA) issued by the American Health Information Management Association (AHIMA)
    • 100 multiple choice questions
    • Exam time 2 hours
    • Cost: $199 for members, $299 for non members
    • Every two years you will be required to submit 20 CEUs plus additional fees
  • The Certified Coding Specialist (CCS) credential issued by AHIMA
    • Eligibility requirements include many options one of which the CCA credential PLUS 1 year of coding experience
    • 97 multiple choice questions, 8 medical scenarios
    • Exam time is 4 hours
    • Cost: $299 for members, $399 for non members
    • Every two years you will be required to submit 20 CEUs plus additional fees
  • Certified Medical Billing Specialist (CMBS) from the Medical Association of Billers (MAB)
    • 100 multiple choice questions
    • Cost: $199, Also requires membership to MAB, varies from $75 to $115
    • Requires 12 continuing education units (CEUs) per calendar year

​The exams all generally cover the same material including:

  • Medical terminology
  • Anatomy and physiology
  • Medical coding
  • Medicare and private insurance claim processing guidelines
  • Handling denials and appeals
  • Maintaining regulatory compliance and avoiding accusations of fraud or abuse

Although there is no state or Federal requirement of a medical billing professional to become certified to practice medical billing, benefits may include networking opportunities, training and education resources, recognition of industry knowledge and access to jobs.

If becoming a medical billing and coder is not for you, but you still want a career in health – explore other medical assisting careers.

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