Medical coding and billing aren’t mutually exclusive, but the terms are often used interchangeably. In larger practices, coders collect documentation and insert codes on reimbursement claims, while billers transmit the claims and monitor their progress.
In smaller practices, a single individual fulfills both coding and billing functions. In this article, Nitin Chhoda discusses the important roles and factors to consider when deciding to be a professional biller or coder.
Coders don’t have to endure years of training and can enter their profession in fairly short order, but they do undergo intensive education in a variety of specialties.
As they pursue their passion, they will be called upon to perform a variety of duties and will have multiple venues from which to employ their skills.
With mandatory implementation of EMR or electronic medical record technology, the job outlook is excellent for billers and coders.
A diploma or associate degree for billers or coders opens the door to a wealth of educational opportunities for entry level positions. Billing or coding diploma and certification programs are available at learning institutions throughout the U.S., along with online education from reputable professional organizations.
Education will cover compliance issues, industry codes and procedures, medical practice management, ICD-9 and CPT coding, technology systems and clearinghouses.
A majority of coding programs require students to be proficient in medical terminology and anatomy, while others include it as part of the program to become a Certified Professional Coder®.
Abbreviated and condensed education plans can be completed in as little as nine months, but the average is from 15 to 18 months. Billers or coders course fees run the gamut, from $600 to $2,000. Add approximately $500 for textbooks or CDs and accompanying materials.
Knowledge in Coding Basics is a Must
Those who pursue to become a coder will be required to know CPT and ICD-9 codes. The alpha-numeric codes provide a description on claims that supports a clinician’s diagnosis and treatment for his/her patient. ICD-9 codes will soon be updated to the ICD-10 standard.
The codes tell insurance companies the services they’re paying for on behalf of their subscriber.
Coders are also fact checkers. They will need an understanding of medical terminology and anatomy to code accurately and ensure practitioners receive the fees they’re due.
Coders will confer with clinicians to clarify any data that appears to be in error or if there’s any uncertainty associated with the available documentation.
The Software to Use
Professional coders will enter coding information into specialized software programs or electronic medical record (EMR) systems. Electronic medical records will soon be the mandated method of communication for healthcare professionals and facilities.
EMR technology has the advantage of functionalities that can assist coders in identifying potential coding difficulties before the claim is transmitted to clearinghouses. Such advantages which can help coders and billers with their EMR system are the following:
- Online eligibility verification function
- Auto patient chart creation
- Create custom templates
- Scrub claims
- Automatic posing of ERAs
- Generate patient statements and much more…..
Billers and Coders Employment Opportunities
Coders and billers are in high demand and the trend is expected to continue unabated. They may find themselves working in a clinician’s office, hospital or pharmacy. Any medical office or entity that provides patient services will need a coder.