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.