Medical billers and coders work for insurance companies, medical offices, hospitals, clinics and pharmacies. Sometimes they work as full-time employees, but some work as self-employed freelancers. Whether they work for themselves or for a company or hospital, they might work in an office setting or telecommute from home. Their jobs are pivotal for the healthcare industry as they make sure providers receive payments for services rendered.
Medical billing and coding are often link together, but these are two distinct and crucial jobs. Medical coding involves extracting information from patient healthcare visits and creating a claim so the provider can receive payment. The process involves applying the appropriate healthcare codes, which are crucial for accurate claim payment.
Conversely, a medical biller’s role is to interpret medical codes and send the claim to the appropriate insurance company, agency or private payer. Sometimes these roles are split and several people carry out the processes. Other times, one person bears the responsibility of the roles.
While in past years a high school diploma was sufficient for people interested in the medical billing and coding field, in the 21st century, advanced training is crucial for improving knowledge and job potential. Candidates interested in this field can pursue various degrees that can lead to successful transition in this career area. For example, some colleges in Philadelphia offer associates degrees or certification specifically in medical billing and coding.
Medical billers must be well versed in the healthcare industry. They must be familiar with health insurance plans, insurance companies, and prescription discount programs. Medical coding is their bread and butter, so they must be familiar with current procedural terminology (CPT) and international determination of diseases (ICD) codes. It is also crucial that they are well versed in the Healthcare Common Procedure Coding System (HCPCS). Medical billing and coding specialists also must be knowledgeable about the various healthcare laws, including HIPAA regulations, the False Claims Act, and the Fair Debt Collections Act.
Medical billers and coders insure that claim information is accurate and help make sure claim payment is expeditious. These detailed-oriented individuals find and eliminate errors and inconsistencies,. They keep information flowing between healthcare providers and payment systems. This process is crucial because it helps ensure that patients continue to receive timely healthcare services.