In the United States, medical billing and coding is a process by which healthcare providers and facilities submit claims to insurance companies and Medicare to receive reimbursement for services rendered. As this process is ever-changing, it is essential to have certified professionals who know the latest medical coding changes to ensure that claims are submitted correctly and on time.

What Is Certified Medical Billing And Coding?

Certified medical billing and coding is a process of organizing and managing medical billing information and patient records. Because the medical billing and coding process is notoriously complex, certified medical billers and coders have specialized training to handle this work.

Medical billing and coding are used to create patient records, process insurance claims, and track payments, which is vital for both patients and medical providers. Patients rely on medical billing and coding to ensure that their medical bills are accurate and that their insurance claims are processed correctly. On the other side, medical providers use medical billing and coding to manage their finances and ensure they are paid for their services.

Certified medical billers and coders use specialized software to manage medical billing and coding data. This software includes features to help with claims processing, payment tracking, and patient records management.

As their work can be time-consuming and layered, certified medical billers and coders must appeal to their training and experience to handle this work promptly and accurately. This work requires attention to detail and a strong understanding of medical terminology.

Why Is Certified Medical Billing And Coding Important?

It is important to have certified medical billers and coders because of their familiarity with the many different coding systems used in the online medical billing process. These systems are constantly changing, and it is vital to have someone familiar with the most recent changes to avoid delays in reimbursement, which can be costly.

Another reason why medical coders are essential is that they understand the claims process and how to appeal denied claims. Denied claims are common in the medical billing and coding process, and it is crucial to have someone on your team who knows how to appeal these claims to get the reimbursement you deserve.

Finally, certified medical billers and coders are essential because they can help you to avoid common mistakes that can lead to delays or denials in reimbursement. They can also help you to optimize your billing and coding processes to maximize your reimbursement.

How Do You Become A Certified Medical Billing And Coding Specialist?

The medical billing and coding specialist certification process typically involves completing an accredited postsecondary program and passing a certification exam.

Most medical billing and coding programs take one to two years to complete and are offered at community colleges and technical schools. During the program, students take medical billing, coding, and healthcare administration classes and learn about different coding systems and medical terminology.

Upon finishing the medical billing and coding program, the next, and most challenging step, is to pass a certification exam. The two main certification exams for medical billing and coding specialists are the Certified Professional Coder exam and the Certified Coding Specialist exam. The American Health Information Management Association (AHIMA) offers both exams.

To be eligible for the Certified Professional Coder exam, candidates must have at least two years of professional coding experience. However, there is no experience requirement for the Certified Coding Specialist exam.

The Certified Professional Coder exam consists of 150 multiple-choice questions and covers medical terminology, anatomy and physiology, coding guidelines, and reimbursement methods. In contrast, the Certified Coding Specialist exam covers topics such as diagnosis coding, procedure coding, and medical records in 175 multiple-choice questions.

Both exams are offered year-round at testing centers across the United States. To find a testing center and register for the exam, eligible candidates can visit the AHIMA website.

After passing the Certified Professional Coder or Certified Coding Specialist exam, medical billing and coding specialists can apply for state licensure. Although most states do not require medical billers and coders to be licensed, some states have various certification or registration requirements.

Medical billing and coding specialists often seek voluntary certification in specialty areas, such as hospital or physician practice coding. Specialty certifications can demonstrate higher expertise and may help coders advance their careers.

Medical Billing And Coding Certification – What Are The Different Types?

There are many different types of certified medical billing and coding certifications. The most common are the Certified Professional Coder (CPC), Certified Outpatient Coding (COC), and Certified Inpatient Coding (CIC).

The CPC certification is the most widely recognized coding certification from the American Academy of Professional Coders. To receive the CPC, coders must pass an exam that tests their knowledge of international classification of diseases (ICD)-10, CPT, and healthcare common procedure coding systems (HPTCS).

The COC certification is from the American Health Information Management Association and is a highly sought-after coding certification. To earn the COC certification, coders are required to successfully test their understanding of ICD-10, CPT, and HCPCS coding systems, similar to the CPC certification.

The CIC certification is from the Board of Medical Specialty Coding and is a slightly less common coding certification. To earn the CIC, coders need to take an exam focusing more on the ICD-9 than the ICD-10.

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FAQ

How Much Do They Earn?

Average salaries for certified medical billing and coding specialists are about $37,000 per year, and the top earners in the field make over $50,000 per year. However, salaries can vary depending on experience, location, and employer. Those with more experience and who work in more extensive facilities tend to earn more.

How Popular Of An Occupation Are They?

The job outlook for medical billing and coding specialists is positive, with a projected growth of 22% from 2016 to 2026, according to the U.S. Bureau of Labor Statistics (BLS). This is much faster than the average for all occupations. The need for skilled medical billing and coding specialists will grow further with the aging population and the increasing demand for healthcare services.

Should I Conduct A Billing And Coding Audit?

Yes! While the financial expense and time it takes cause many healthcare providers to delay or avoid an audit entirely, regular audits can provide longevity to your business.

Explore regular billing and coding audits with PMN! Our certified medical coders can provide a tailored analysis of your business. Contact a helpful member of our team by calling (949) 215-5055, or visiting our office in Laguna Hills, Orange County, California.