With the passage of new federal guidelines that require health care providers to keep their patient information on secure computer databases, the electronic medical records market has been growing rapidly.
The new guidelines — added to the Health Insurance Portability and Accountability Act (HIPAA) in 2013 — have dramatically increased the demand for medical billers and computer coders, also called medical records technicians and health information technicians.
With spending on software for electronic medical records and electronic health records (EMR/HER) projected to grow to about $3.8 billion in 2015 from about $2 billion in 2009, according to a study by market research firm IDC, medical billers and coders have become vital players in most health care and related businesses.
“Simply, medical billers and coders deal with people’s money,” said Rosa Rossello, founder and CEO of Pennsylvania Medical Billing Inc., in the Philadelphia suburb of Southampton, Pa. “When patients go to a medical provider — physician, physical or occupational therapist, for example — the provider sends the patients’ bills to us for processing so that they can be paid. We process and submit physicians’ bills to insurance companies for payment.”
From that point on, the medical billing process gets complicated, Rossello said.
“We deal with a few different coding systems, because every medical procedure and treatment has its own code,” she said. “Once the codes are entered on standardized insurance forms or claims, and then submitted to patients’ insurance companies for reimbursement, health care providers can be paid.”
Since medical billing and coding became a standard bookkeeping procedure in the early 1980s, the medical billing process has become very structured and sophisticated.
Standardizing and streamlining procedures
Before medical providers were required to transfer all their medical records to computers, patients’ records were coded and stored in cumbersome paper files. With the new HIPAA guidelines, the federal government’s goal is to standardize and streamline all recording procedures, Rossello said.
As the electronic medical records industry grew, “the medical billing and coding process also became increasingly complicated, because the rules and procedures are always changing, and medical records and coding software is constantly being updated,” Rosello said.
That constant pressure on the medical information industry to update and standardize its practices has led to medical billers and coders becoming critical cogs in the nation’s health care industry.
Highly specialized field
Medical billers and coders are employed by health care providers, insurance companies and billing companies of all sizes. Their job titles vary according to their particular functions. Large health care providers tend to separate the functions and hire both medical billers and medical coders.
“When medical procedures are performed, coders look at patients’ charts and assign codes to each procedure,” Rossello said. “They have nothing to do with the billing process.”
Pennsylvania Medical Billing combines the coding and billing functions. To reflect their broad job responsibilities, Rossello calls her billing professionals “billing coordinators,” because they have a hands-on knowledge of the billing, coding and collection process.
“We’re involved in the entire process, from patients’ encounters with health care providers to getting providers paid,” Rossello said.
Pennsylvania Medical Billing’s clients are smaller medical practices, such as family practitioners, psychiatrists, psychologists, physical therapists and chiropractors.
While medical coding is a specialty all its own, Rossello said there is a greater demand for medical billers, because they’re required to have a working knowledge of both the billing and coding processes.
Combination of skills
It takes a few different skill sets to be a successful medical biller, with analytical skills at the top of the list, Rossello said.
“It also takes organizational skills, because medical billers have to be able to multitask and keep track of many things at the same time,” she said.
Along with understanding medical terminology, anatomy and medical-billing procedures and terminology, medical billers also have to be comfortable with computers, especially word processing, database management and spreadsheets.
Good communication skills are also important, Rosello said, because billers must be able to explain charges to patients so that the patients understand what they are paying for.
Medical billing and coding is taught at technical vocational schools and community colleges. Rossello prefers candidates who have a medical billing and coding certificate from an accredited school, along with certification from either the American Academy of Professional Coders (AAPC) or from the American Health Information Management Association (AHIMA).
To learn more about certification requirements, along with information about the medical billing/coding field, visit the AAPC website and The American Health Information Management Association website.
Bob Weinstein is a workplace journalist, syndicated columnist and author of 13 books.