Medical Billing and Coding…..Is it Billing? Is it Coding? How do I choose?

, ,

Almost everywhere you turn today you see the combination of Medical Billing and Coding or Medical Coding and Billing tied together in some way shape or form so many people, if they are not familiar with the medical profession may believe that they are one in the same process.  In reality, they are really quite different.  This is a good thing because there are often times that people come into this specialty thinking “I want to be a coder” until they start seeing what exactly the job entails and they quickly realize that this responsibility is not for them so they automatically begin to think “Great, I chose the wrong profession”.  That is not the case.  Not everyone is meant to be a coder and that is perfectly fine to discover.  It takes a special mind set to be able to wrap your brain around all of the concepts and processes that need to take placed to be an effective coder and not everyone fits that bill.

So, if not a coder, what then is there for me to do?  There is the billing aspect of this profession to consider.  Here the responsibilities are just as important as on the coding side of the process because it is the billers that ensure that the claims are properly filled out, correctly submitted to the insurance companies for processing, follow up on outstanding claims that have not been processed by the insurance company, The Medical Biller is responsible for knowing and understanding the parts of the different insurances  in their geographical area, may handle the accounts receivable in a working environment,  work on submission of secondary insurance claims, responsible for correcting and reprocessing rejected claims and the list goes on and on.

There is a whole other world that exists in the medical profession outside of being a coder and that is the Medical Biller.  Now often times, Billers and Coders work closely together to help ensure that claim information is correct to expedite the processing of the claim for proper reimbursement which is a great way for the system to work but to be honest, the system needs both of these parts for the whole process to work as one.  Without one side or the other, you will find that there will be delays, errors, hold ups, mistakes, and all around major problems.

So, have you wondered what Medical billing and coding really is?  Have you ever asked yourself if it was one or two positions?  As you can see from above, there are many more than just two positions that exist in this realm which is great because it provides many different pathways for those that are looking for something different.  If you do not want to be a coder, do not think that this will prevent you from working on this side of the administrative process of the medical profession.  There is more to this profession than just coding.  Research this
and see what the pathways may be.  Billing can provide many different veins for you to take advantage of and the choices are yours to make.

If you are considering a change in career, Billing and Coding may be a great pathway based on the opportunities outlined above.  Now all you have to do is decide where and how you are going to obtain that education you are going to need to move forward on this career decision.  Hopefully you will find that this will help with making your decision in moving forward. What do you have to lose? Not sure coding is for you? Then take that billing course first as it should introduce you to the use of the coding references used in the profession and once through your introduction of the coding material if you find you really liked the coding aspect then look to expand your education  pathway to pick up some coding classes after your billing course is completed. After all, some of the best coders today were billers before they became coders.  Feel free to leave your thought. May you have a Happy New Year and may you make this a New Year’s resolution that you follow through on.

Productivity in Medical Transcription and Documentation – Expand Responsibly

, , ,

As a healthcare documentation specialist – whether our title is medical transcriptionist, editor, or medical language specialist – our pay may be largely based on productivity.  Often it may seem that productivity becomes front and center – after all, this is our livelihood.  More lines means more money!

Well, yes, BUT (and it’s a big but).  At the risk of sounding preachy, let’s not forget that our first responsibility is to the patient and ensuring that the information we are documenting for them is accurate.  Look at it this way:  Sometimes, you are the patient.  How do you want the healthcare documentation specialist to treat your record?

Fear not.

There are ways to maximize productivity without sacrificing quality, and vice versa.  Efficient use of references and research skills, reducing interruptions, taking rest breaks, and having an ergonomically sound workstation are all important.  There is one tool, however, that most specialists use or rely on in some way – the expander program.  This can be either through the use of the automatic text features in word processing programs, through the expanders/normals feature of a documentation platform, or through commercial software that we can purchase that will “pair up” with the systems we are using.

With expander use comes great responsibility.  While expanders will save many, many keystrokes (and sometimes full paragraphs of text), there can be some drawbacks to their use.  Probably the most obvious is the increased chance of inserting incorrect text.  Your doctor asks you to keep a diary for your headaches, not a diarrhea.   The patient’s name is Bob, not bowel or bladder.  The expander software I’m using right now tells me that my entry of AAA can be either abdominal aortic aneurysm, after adequate anesthesia, or awake and alert; if I’m not paying attention, the awake and alert patient could have some more pressing problems at hand.

Clearly, in addition to being responsible in our expander usage, proofreading the reports is just as important regardless of whether or not we use expanders.

Another drawback to using expanders is the potential of dampening our skills over time.  If we consistently use shortcuts, we may not immediately recall how to spell hydrochlorothiazide, uvulopalatopharyngoplasty, and gentamicin.  Should the patient be seen for a follow up visit or a followup visit?  It may be worthwhile to turn off the expanders from time to time; this will likely pay off in the long run.

What has been the most important tool or practice for you in increasing your productivity and maintaining accuracy? 

Medical Scribe-The Job Description!

, ,

Medical Scribes are individuals trained in medical documentation who assist a physician throughout their shift. The primary goal of a Medical Scribe is to increase the efficiency and the productivity of the physician they are working for. The Medical Scribe allows the doctor to focus on what is most important, the patient.

A summary of a Medical Scribes duties include performing all clerical and information technology functions for a physician in a clinic setting. This includes primary responsibility of the operation of the electronic health records and electronic dictation system. You also must be able anticipate physician needs to facilitate the flow of clinic. Medical Scribes must be discreet, tactful, and modest in performance of duties so as not to distract medical staff from patient care.  Good judgment, organizational ability, initiative, attention to detail, and the ability to be self-motivated are especially important when working as a Medical Scribe.  You must be adaptable and versatile since you will be responsible for many tasks. Good attendance is also an important element of this job since you will be hard to replace.

Some of the more detailed job duties and responsibilities of a Medical Scribe are:

1.         Accurately and thoroughly document medical visits and procedures as they are being performed by the physician, including but not limited to:

  • Patient medical history and physical exam,
  • Procedures and treatments performed by healthcare professionals, including nurses and physician assistants.
  • Patient education and explanations of risks and benefits.
  • Physician-dictated diagnoses, prescriptions and instructions for patient or family members for self-care and follow-up
  • Prepare referral letters as directed by the physician

2.         Dictation/faxing/phone calls and clerical tasks. Medical Scribes are asked to prepare referral letters as directed by the physician, via dictation or summary of the medical record. Medical Scribe also ensure that letters are mailed or faxed on a daily basis to all physicians involved in a patient’s care, and with all copies of pertinent reports or tests attached.  You may be asked to research contact information for referring physicians, coordinate referrals, prepare operative reports, make phone calls, and other clerical tasks as assigned.

3.         Medical Scribes also spot mistakes or inconsistencies in medical documentation and check to correct the information in order to reduce errors.  All addenda must be signed off by a physician. Medical Scribes ensure that all clinical data, lab or other test results, the interpretation of the results by the physician are recorded accurately in the medical record.  Alert physician when chart is incomplete. Medical Scribes must comply with specific standards that apply to the style of medical records and to the legal and ethical requirements for preparing medical documents and for keeping patient information confidential.

4.         Medical Scribes collect, organize and catalog data for physician quality reporting system and other quality improvement efforts and format for submission. You will assist in developing and maintaining systems to track patient follow up and compliance.

5.         Attend trainings on diverse subjects such as information technology, legal, HIPAA and regulatory compliance, billing and coding. Quickly assimilate new knowledge into processes and procedures. Medical Scribes proofread and edit all the physician’s medical documents for accuracy, spelling, punctuation, and grammar.

Qualifications:  To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1.         Language Skills – The ability to write routine reports and correspondence. Medical Scribes must be proficient in typing and good at spelling, punctuation, grammar, and oral communication. Must be able to listen to complex medical information and summarize in a clear, complete, and concise fashion. Excellent English composition skills required to generate professional, polished writing at a high rate of production. Handwriting must be clear and legible.

2.         Understanding of medical terminology, anatomy and physiology, diagnostic procedures, pharmacology, and treatment assessments to the extent required to understand and accurately transcribe dictated reports. Translate medical abbreviations into their expanded forms.

3.         Mathematical Skills – Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Prepare and interpret charts and graphs. Have the ability to compute ratio and percent.

4.         Reasoning Ability – Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to apply logic and draw conclusions based on knowledge. Have the ability to refer to reference materials to solve problems.

5.         Computer Skills – To perform this job successfully, an individual should be able to learn and use all functions of electronic medical record software and transcription software. Must accurately enter data into a database, search for information, send and receive email and attachments. Must be proficient in Microsoft Word in order to prepare correspondence, medical reports, and other documents. Must use Microsoft Excel to prepare flowcharts and organize data. Must use the internet to access schedules, research information, etc.

6.         Other Skills and Abilities – Must be able to type words and numbers quickly and accurately; must comply with HIPAA confidentiality standards when accessing or communicating patient information.

7.         Physical Demands – While performing the duties of this Job, a Medical Scribe is regularly required to stand; sit; walk; use hands to type, write with a pen, finger, handle, or feel; reach with hands and arms and talk or hear. The Medical Scribe is occasionally required to climb or balance and stoop, kneel, crouch, or crawl. The Medical Scribe must regularly lift and /or move up to 10 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, depth perception and ability to adjust focus.

As you can see, Medical Scribes are an invaluable asset to physicians in busy emergency departments, hospitals, or clinics. With more time to focus on interacting with their patients, doctors see more patients while the Medical Scribe is documenting the patients visit and care plan – alleviating that burden from the doctor. Medical Scribes are fast becoming more and more important to a doctor and a profession that is in high demand.

Do you have what it takes to become a Medical Scribe? Find out more!

Coding/Billing Certifications…..Do you have one?

, , ,

Have you looked in the paper lately for a position in the coding or billing field? Maybe researched the internet for either of these types of positions recently?  Sometimes it can be hard to locate a specific position depending on how the perspective employer has the opening posted  for those searching for employment, so one challenge would be to know how to search for the position you are interested in to start.  The medical profession is more than just billing and coding.  There are many different facets that encompass those two terms.  When you are looking at coding you generally have your inpatient facility coders, your outpatient facility coders and your physician coders. The coding positions break out into a few more levels from here but these are the basic threads when you start talking about coding.

From the billing aspect, there are many different facets that fall under this term and many are often overlooked.  You would find your registration specialist (which may also be known as your intake specialist and depending on the environment your front desk receptionist),  referral specialist, surgery scheduling specialist (or coordinator),  appointment scheduler, data entry clerk, insurance claims reviewer, claims processer, customer service specialist, accounts receivable specialist and the can carry on from there as well. As you can see if you work in the environment or if you are getting ready to enter the environment there are many different pathways you can select, the options are plentiful and many if you have at least one thing.  That one thing happens to be the one item that most positions are searching for today in some realm and that would be a certification.  Some employers depending on the pathway you select are looking for the completion of a billing and coding program or an Associate’s degree depending on the employers accreditation requirements.  There are still some positions that are still accepting just a high school diploma or the equivalent which is wonderful but you are starting to find that those positions are becoming fewer and far between.

So, how do you decide on a certification? Which certification should you get? Is there one better than the other?  This is a decision that only you can really make for yourself.  The best way to make this decision is to gather the facts together so that you can make the best educated decision that you can that will benefit you for what you are looking to do in this profession.  Can you have more than one certification? Yes, you can and you will find that many certified individuals in the profession are cross-certified holding certifications with different organizations.  We all made decisions that best suited us for our needs and you will need to do the same.  So here is a brief road map for you to review the most popular certifying organizations that are commonly known to give you an idea of what you are working with.  Just for the sake of documenting, I will list the organizations out in alphabetic order as it is easier to keep track that way when providing details.

American Academy of Professional Coders (also referred to as AAPC):  Provides certifications for physician based coding-CPC, outpatient hospital coding-CPC-H, payer coding-CPC-P (for health plans/insurance company coding staff).  You can find out more specifics by visiting the AAPC at www.aapc.com.

American Health Information Management Association (also referred to as AHIMA): Provides certifications for medical records as well as coders so there are some different options here to choose from depending on the pathway you are looking at taking your career. From the coding aspect, the certifications offered would be inpatient and outpatient facility coding-CCS and physician based coding-CCS-P. To check out all of the certification options that AHIMA offers, visit their website at: www.ahima.org.

Medical Association of Billers (also referred to as MAB): Provides certifications for those interested in the billing side of the profession. This certification would be a great way to demonstrate your commitment to your profession much like a coding certification does for a coder.  To find out more about what the MAB has to offer, check out their website at: mabillers.com.

National Healthcareer Association (also referred to as NHA): Provides a wide variety of certifications in many different disciplines in the healthcare field. Three different certifications that may be of interest may be the Certified Medical Administrative Assistant-CMAA, Certified Electronic Health Record Specialist-CEHRS and the Certified Billing and Coding Specialist-CBCS.  Depending on which pathway your career is taking you, these could be beneficial to assist you in your current endeavors or future endeavors.  To find out the details on these certifications, research their website at: www.nhanow.com/home.aspx.

Professional Association Healthcare Coding Specialist (also referred to as PAHCS): Provides a Certified Basic Medical Coding Specialist-CBMCS certification for those individuals that may just be entering the profession from some type of coding and billing/HIM program. You can find out more on their organization and what they have to offer by visiting their website: www.pahcs.org.

So as you can see by the brief summary that I listed above, there are a number of organizations in the profession that you can take advantage of to obtain a certification for this profession.  So if you do not already have one, what are you waiting for?  If you do already have one, why not look at expanding your knowledge and gaining a new one.  The more certifications you hold, the more marketable you become. The choice is yours, the time is now, the opportunities are there and the employers are telling you what they are looking for.  Step up and prepare yourself for the next step in your career.  It is not going to come to you; you have to go after it.

A Call-out To U.S. Hospitals To Help Put Americans Back to Work!

, , , ,

The #1 issue during last week’s Presidential debate and the #1 issuing currently facing our country is unemployment. The unemployment rate is currently hovering around 7.8% and depending upon who’s numbers you believe somewhere between 12 and 23 million Americans can’t find a job! That’s a travesty!

People who can’t find a job, can’t pay taxes and find it difficult to pay for healthcare – as a result, hospitals are facing declining revenue, budget cuts and possibly their own layoffs!

What can you do about it?

Recognize that many large medical transcription service organizations are sending your dictation off-shore and taking the jobs that go along with it. In some cases we’re talking about thousands of jobs. And if that’s not bad enough…they are also charging a handsome price for it too!

What can you do about it?

Decide today to send some of your work to a company which uses 100% U.S. based labor resources.

Who are we?

The American Healthcare Documentation Professionals Group is a team of experienced industry professionals who are ready to provide your organization with high quality documents, fast turnaround and exceptional customer service at a fair price. We have been providing outsourced transcription services since 1992; we use only U.S. based labor and are “platform independent.”

Our “platform independence” allows you to use whichever technology is currently in place thereby eliminating any disruption to your operations. It also allows us to step in immediately.  And don’t worry, in the event you require the use of a technology platform, our “platform independence” allows us greater flexibility to provide the one that best suits your needs.

Since 1992 we have gained experience working with all the major platforms including 3M, Arrendale, Dictaphone, Dolbey, eScription, IDX, Infraware, MedQuist, MModal, Nuance, McKesson, etc. and as a premium level service provider we bring significant benefits to our client relationships, including:

  • A seasoned management team.
  • A commitment to use only U.S. based Healthcare Documentation Specialists.
  • Available production capacity to adequately staff your account 24x7x365.
  • Ability handle all types of work – HIM, Radiology, Cardiology, etc.
  • Editing or straight transcription.
  • A proven Quality Assurance program.
  • A commitment to pricing transparency.

Most importantly, we understand the important role our services have on your ability to provide high-quality, cost-effective patient care.

With so many Americans out of work don’t let the recent industry consolidation force you to accept:

  • Unwanted technology or platform changes
  • Detached customer service
  • Reduced quality
  • Reduced turnaround time compliance
  • Increased physician dissatisfaction

For all the right reasons, including putting Americans back to work, give us a call today and let’s setup a time to see how we can do our part and get America moving again!

If you give us a chance, we bet we can do the work for the same price (maybe even a little better) as you are currently paying…but we will put the money in the pockets of hard working Americans!

It’s a win for you, it’s a win for our neighbors and it’s a win for our country!

Contact us at 800-407-1186, extension 3 for more details.   We are the company that is large enough to perform but small enough to care!

ICD-9-CM / CPT Updates and Changes for 2013

,

Here we are, October 1 right around the corner which means that 2013 ICD-9-CM goes into effect.  This means that as of Monday, October 1 everyone should be putting their 2012 ICD-9-CM references away and pulling out their 2013 references for use first thing in the morning.  Now a question you should consider, should I be attaching 2013 ICD-9 codes to services that were performed prior to the October 1 date?  The rule of thumb is that the 2013 ICD-9 code sets go into effect for services starting on October 1.  So as you are working through your coding work load over the next few weeks (because we all know that there is always a slight turn-around time when coding) keep an eye on your date of service to be sure that you are attaching yourproperICD-9-CM code sets.

This process could be a bit tedious, couldn’t it? Would you like an easier way to keep track of this process?  It is actually really simple and a process that you should always complete when you receive a new coding reference.  In each of your coding references, you will find a listing of updates and changes that have been made in your new code book.  In your ICD-9-CM reference it is located in the front of the code book.  Look these over to see if any of these changes will affect any of the common codes you use on a regular basis.  If there are changes, make yourself a note in your new code reference to refer back to your prior reference when coding that said code.  This makes this process much easier to manage.

When we reach January, 2013, be prepared for over 700 changes, revisions, and/or deletions to the 2013 CPT reference.  There are seminars that are now being advertised as well as webinars to highlight and review these updates if you are interested.  Also be aware that these updates and changes will also be listed in your CPT book in Appendix B so if you are not able to make it to any of these seminars or webinars, you will have this information for your review when you receive your new CPT books which should be currently shipping.

Now just to bring everyone up to speed, there are limited changes to the 2013 ICD-9-CM as the profession is preparing for the transition to ICD-10.  So you will not see much on information for the revisions, updates and changes to the ICD-9-CM as the profession is gearing up for ICD-10 which is set to be implemented October 1, 2014 as of the last publicized date. Be sure you are taking the steps you need to be sure that you are ready and prepared for the roll over to the new code sets that are coming into effect as the year comes to an end.  If in doubt, research, network and ask questions.  It is always better to query than to run blind in this profession.

Healthcare Jobs on the Rise! Are you prepared?

, , , , , , , ,

According to the U.S. Bureau of Labor Statistics, employment of medical assistants and medical records and health information technicians is expected to grow by 31 and 21 percent respectively by 2020, much faster than the average for all occupations. Demand will stem from physicians hiring more medical assistants to do routine administrative and clinical duties so that physicians can see more patients. As a result, the time is now, for individuals interested in training for a rewarding, stable career in healthcare. AHDPGTM has added a few new courses to help you prepare for this growth.

The Medical Administrative Assistant training program provides students a well-rounded introduction to medical administration and delivers the skills students require to obtain an administrative medical assistant position or advance within their current healthcare career.

The Clinical Medical Assistant training program prepares students to assist physicians by performing functions related to the clinical aspects of a medical office. Instruction includes preparing patients for examination and treatment, routine laboratory procedures, pharmacology, taking and documenting vital signs, technical aspects of phlebotomy, the 12-lead EKG and the cardiac life cycle. This program also includes an optional clinical externship at a local healthcare provider!

The ICD-10 Medical Billing and Coding training program reviews key elements of the changes from ICD-9 to ICD-10 and examines the impact of this change on the U.S. healthcare system. This course was designed to specifically support the U.S. Department of Health and Human Services (HHS) recent decision to move forward with the transition from ICD-9 to ICD-10 in October, 2014.

The healthcare reform’s emphasis on electronic health records is driving an increased need for “competently” trained individuals to support patient care. As a result, healthcare documentation roles (i.e. medical transcription editing, medical billing, medical coding, medical scribes and medical assistants) are high-growth areas with a shortage of qualified candidates. AHDPGTM is committed to make online job training and career development programs widely accessible to individuals interested in filling these vital jobs.

MBC Updates and Changes for 2013…Are you ready?

, ,

Updates and Changes happen very frequently in the billing and coding profession.  One day you may be using a code set a specific way only to find out a month later that the process has changed and the way you were using the code is no longer the proper way to apply the code.  Changes happen every day and it is vital to stay abreast of these changes in our profession.

As we are getting ready to start September already (I know, very hard to believe) we are preparing for new ICD-9’s, new CPT’s, and new HCPCS codes and now more than ever we need to find out what codes are new, what codes are changed and more importantly what codes have been deleted for the 2013 calendar year.

If you have the opportunity, this is the time to attend webinar’s or seminar’s to find out what changes are occurring.  Many organizations offer these meetings that can be as general as you are looking for and as detailed as you are looking for if you attend a specialty specific session to find out the changes that are up and coming.   Remember that the 2013 ICD-9 code book goes into effect on October 1  and the 2013 CPT and HCPCS books go into effect on January 1, 2013.  This becomes one of the busiest parts of the year for coders and billers to be sure that we are updated and ready for the 2013 calendar year.  Be sure you are ready for the updates and changes so that you are not caught unprepared.  Start planning now…..

Malware? Is that really a word?

,

Since the internet age, health-care documentation (ie medical transcription) services have been made widely available to users via remote access from anywhere they are, providing they have internet access. That is one of the perks for this business. It’s a portable job and folks can do it from just about anywhere for the most part.  The down side from working from outside a corporate network is that the average user doesn’t really think about being infected by  some of the “bad” things that come from being on the internet. All that stuff was typically handled by the goofy guy with the glasses and pocket protector down the hall in the corporate office. I am sure most of you have heard the term “Malware”. That is the acronym for Malicious Software. The bad part about this is that you typically don’t even know you were infected until all of a sudden things stop working as they should and the computer starts getting slower and slower. Most folks say “I guess it’s time to get a new computer; this one is getting to slow to do the job”.   While new technology and hardware are always getting faster and better  and we all love to get that brand new PC out of the box, fire it up and grin ear to ear how fast and snappy it is, that’s not totally the solution. (More on that in a moment) Malware will take its toll on even the fastest PC’s.  Here are some interesting facts:

  • Experts estimate that 48% of all computers on the internet are infected.
  •  Malware is transmitted from infected photos, infected PDFs, infected Java files, ActiveX controls that take advantage of Windows/Internet Explorer vulnerabilities and numerous other means.
  • A new virus is released on the Internet every 30 seconds.

Here’s the problem – the nature of this new malware is that it is hard to detect, often hiding on hard disk boot tracks. It’s hard to remove often requiring complete re-installation of the operating system, and anti-virus software alone no longer works against it.

OK have I made you want to cut off your PC and sit and look at its dark screen sitting in the corner in fear that it will be attacked at any moment? Good but that was not my intent.  The intent was to make you aware how fast you can be shutdown by some vicious website or document someone emails you. Anyone who works in health-care documentation knows the importance of staying online and being productive.

Now for the good news.  There are some great anti-viruses and anti-malware solutions available and some of great ones are free. In today’s world it’s no longer ok to just have an antivirus program on your machine. It takes a team of applications and some paying attention to keep you humming along. And yes that old PC can run a lot better and you can get more mileage out of it if its cleaned up by deleting unneeded older applications, making sure it has the latest updates for the particular operating system (Windows) and making sure you have updated antivirus/anti-malware software and of course running a scan or two every  now and then. A full format and reinstall of Windows and your needed applications is a great way to bring that old computer back to life verses throwing it away but it takes some time and patience to do so. Certainly an alternative than shelling out bucks for a new one.

While there are lots of great applications available, one that is a must have for every user is called MalwareBytes ( www.malwarebytes.org ). It does an extraordinary job of cleaning up infections cause by Malware. And there is a free version that works as well as any I have seen.  I highly recommend taking a look at this one and installing and running a scan. You just may be surprised at what it turns up.

Facility Environment or Provider Environment…Which One Is Right For You?

, , , , , ,

As a person views the medical profession they see registration staff, medical assistant staff, nursing staff, transcriptionists, billers/coders, insurance staff and collection staff. Seems pretty straight forward until you look closer at what is really available within the profession. Focusing on the billing and coding side of things, have you ever really thought about what the options are for this specialty? As a new comer to the profession, many people have no true idea of what all is in store for billers and coders. Those of us that have been around for some time understand the avenues we have that open up to us as billers and coders and respect what choices we have in this field.
When you look at the billing and coding staff in the profession, you have to look closer because what you may think is more than likely just a scratch on the surface. Billers and coders work as registration specialists, referral specialists, schedulers, health information specialists, customer service representatives, data entry specialists, insurance processors, reimbursement specialists, claims adjudicators, collection specialists and that is just to list a handful of positions a biller/coder can hold in this field. The opportunities once you have been trained within the billing and coding field really becomes endless depending on your desire, need and passion for the career.
There is then even another avenue that you need to consider when looking at this profession and that would be working in an acute care facility, rehabilitation facility, surgery center, skilled nursing facilities, insurance companies, or provider offices. There are differences on how each environment works to complete their daily tasks of billing and coding care and treatment. What is the difference between facility and provider? Let’s take a look at these differences.
Facility coding involves coding with ICD-9 and DRG codes for inpatient care and using CPT codes for outpatient care. Generally facility coding allows a coder and biller to become a specialist in a specific insurance. This can entail abstracting information from just a few pages of information to volumes of medical information depending on how long the patients stay was in the facilities. The coding cycles could be as they occur, once a month or at the end of their admission depending on what type of facility you are working in. Arrangements are determined by each type of facility as to their preference. Generally the expected work load would be coding for a said insurance, billing for that specific insurance, posting revenue for that said insurance and then refilling claims when needed for that said insurance. The facility environment has a biller/coder responsible for the entire process for a said insurance company so they become very proficient with that entity. This helps to streamline the overall tracking process of services/procedures performed and ensures that things do not fall between the cracks with as many patients a facility may see in a months’ time.
Provider coding involves coding for office services as well as facility services that are performed by your provider. Hospital consultations, rounding visits, reading of diagnostic studies, surgical procedures, and discharge summaries. From the provider side of things, a biller and coder can be the same and they can also be separate positions in a provider’s office. This will depend on the arrangement of the working environment that the provider has established. It is not uncommon to have distinct coders separated from the billers. It can also be that the coding and billing positions are combined. The opportunities to cross train in a provider’s office are often easier than in a facility due to the structure of the working environments.
Coding from a providers stand point is component coding using the ICD-9 for diagnoses only and CPT for procedures and services performed by the provider. This is one of the biggest differences between facility coding and provider coding. Understanding how these both work becomes beneficial to the coder/biller to allow them opportunities in both types of locations. Understanding your strengths and weaknesses will also help you in deciding, facility or provider?
When deciding which is best for you? You are really the only person that can make that decision. Everyone will have an opinion on which one is better than the other but only you can decide what will work for you. You may want to try both types of working locations to determine which one fits you best. You may want to ask if you can shadow for a day in each style of environment to make the best educated decision. There are pro’s and con’s to both as there is with everything in life. You just need to see which one excites you the most and that will keep you engaged for the career you are looking to have.