Medical Billing and Coding
Medical billing and coding professionals ensure that the healthcare industry has accurate and timely medical data. Medical billers and coders translate a health provider’s descriptions of diseases, injuries, and procedures into numeric and alphanumeric code. The medical code is used for many reasons, such as mortality data, procedural data, and access to medical records by diagnoses and procedures for use in clinical care, research, and education. Medical coders have experienced a surge in career opportunities since the federal government’s mandate to electronically maintain all patient health records.
If you’re looking for a secure career in a fast-growing field, then Medical Billing and Coding could be your answer. With the major changes in health care, Medical Billing and Coding is quickly becoming one of the fastest-growing professions in the United States. Experienced medical billing and coding specialists an average of $32,350 a year.
After you graduate you can go to work for:
Local hospitals or physician offices where:
- You are an employee of the hospital or physician office.
- You work at the hospital or physician office.
Coding Consulting Companies where:
- You are self-employed.
- The consulting company provides you with the accounts.
- You perform coding at the sites you have the accounts with.
National Medical Coding Companies where:
- You are an employee of the company.
- The company supplies you with medical records across the Internet.
- You do not have to reside in any particular location.
Start your own coding consulting business where:
- You contract with your own companies.
- You can hire other medical coders to work for you.
What Does It Take To Be a Successful Medical Billing and Coding Specialist?
When it comes to medical billing and coding, there are two separate approaches that require different training programs. One type of coding provides expertise for outpatient professional medical services for hospital ER’s, clinicians’ offices and private clinics. Generally, these are referred to as ‘Outpatient or Professional Medical Coders’. The second group is made up of individuals who perform facility medical coding for hospitals and other healthcare settings. These people are usually referred to as ‘Inpatient or Facility Medical Coders’. Those who have a desire to launch a career in medical billing and coding career should consider these two options and evaluate the job opportunities in their respective locations before investing in a specific training program.
Characteristics that contribute to the success of a medical coding professional include:
- Love learning something new or desire to learn something new.
- A compelling interest in healthcare.
- Analytical, enjoy reading and solving puzzles (or equations).
- A problem-solver who refuses to give up.
- Good computer skills are essential.
- Ability to follow national or federal guidelines.
- Independent decision-maker.
- Some interaction with administration and insurance carriers.
- Prefers the idea of working in an office.
- Looking for a career that has an excellent future.
This billing and coding program delivers the skills students need to solve insurance billing and coding problems. It details proper assignment of codes and the process to file claims for reimbursement.
This course covers the following key areas and topics
- An overview of healthcare and the insurance industry
- The organization and use of the ICD-10-CM/PCS, ICD-9, CPT, and HCPCS manuals to identify correct codes
- Detailed review and practice using the alphabetic index and tabular list of the ICD-10-CM/PCS and ICD-9
- Detailed review and practice coding examples from all sections within the CPT
- Basic claims processes for medical insurance and third-party reimbursements
- Completing common insurance forms, tracing delinquent claims, and appealing denied claims
Detailed Course Topics Covered
- Introduction to International Classification of Diseases, Clinical Modifications, Coding Guidelines
- Introduction to the organization and use of the ICD-10-CM/PCS, ICD-9 and CPT manuals
- Basics of diagnostic and procedural coding
- The Health Insurance Claim Form (CMS 1500)
- HIPAA and Electronic Data Interchange (EDI)
- Review and practice coding evaluation and Management (E&M) services
- Review and practice coding from anesthesia, surgery, radiology, medicine, and the pathology/laboratory sections of the CPT
- CPT Modifiers, E and V Codes, and Late Effects
- Coding surgical procedures of the integumentary system
- Coding surgical and medical procedures of the cardiovascular system
- Coding procedures related to the female genital system and maternity care and delivery
- Coding for general surgery, radiology, pathology and laboratory services
- Coding for diagnostic and therapeutic services and the Level II National Codes
- Tracing delinquent claims and insurance problem solving
- Third-party reimbursement issues
Education and Certification
- Students should have or be pursuing a high school diploma or GED.
- Numerous national certification exams are available for students who complete this course including the American Academy of Professional Coders (AAPC), the American Health Information Association (AHIMA) and others.
- Certain national certification organizations suggest 6 months to 2 years of practical work experience prior to pursuing certain national certification exams.
This course is online and is a self-paced, mentor-supported course with instructor feedback and assistance as required. Upon completion of the program, a student should be capable of successfully completing the AAPC’s CPC certification exam.
The Medical Billing and Coding program fee is an all-inclusive fee that covers everything a student needs to successfully complete our program. Our program fee covers:
- Course fees.
The Medical Billing and Coding training program is a comprehensive program for individuals looking to launch themselves into an exciting career as a medical billing or coding specialist. This program provides the basic knowledge needed to become “competent,” certified and employable.
Program Title: Medical Billing and Coding
Upon successful program completion, a certificate of completion will be earned and support is offered to our graduates to help secure employment.
Option 1 – Pay Upfront Plan – Save 10%!
The pay upfront program offers a 10% tuition discount for those individuals who are willing to pay upfront for their education.
Option 2 – Military Discount – Save 10%
A 10% tuition discount is available to active military personnel and their spouses.
*The Pay Upfront Plan and the Military Discount cannot be combined and are limited to only one discount.
Option 3 – Monthly Payment Plan
The monthly payment plan includes a one-time initial payment of $295 due at the time of enrollment with the balance billed in monthly installments. A 3% payment processing fee applies, and payments are automatically deducted from your credit card or bank account. Contact Admissions for details.
Option 4 – MyCAA Funding Program
We know that maintaining a career can be difficult with your military lifestyle. That’s why we provide a flexible way to complete your education in careers that are essential nationwide. Learn at home, on your own schedule for a career that will travel with you wherever you go. With MyCAA your education costs maybe 100% covered, meaning you can focus on your future and not tuition costs. The MyCAA Funding program is administered by the Department of Defense.
Who provides certification for Medical Billing and Coding professionals?
Medical Billing and Coding professionals are certified by two national organizations.
- The American Health Information Management Association (AHIMA).
- The American Academy of Professional Coders (AAPC).
The American Health Information Management Associations certifications:
Certified Professional Coder (CPC)
Graduates from the Outpatient Medical Coding Program are encouraged to sit for the American Academy of Professional Coders (CPC, CPC – H. CPC – P) exams.
The CPC® credential validates proficiency in the correct application of CPT®, HCPCS Level II procedure and supply codes, and ICD-9-CM diagnosis codes used for coding and billing for medical claims in a physician’s office.
The CPC-H® credential validates proficiency in the correct application of CPT®, HCPCS Level II procedure and supply codes, and ICD-9-CM diagnosis codes used for coding and billing in an outpatient hospital or facility.
The CPC-P® credential validates proficiency in the correct application of CPT®, HCPCS Level II procedure and supply codes, and ICD-9-CM diagnosis codes used for coding and billing in a payer environment (health plans, Medicare, Medicaid) – where medical claims are processed for payment.
Students without 2-years medical coding experience will be designated an apprentice until they meet the 2-year requirement.
Q: What are the minimum computer requirements for the course?
The minimum computer requirements in order to successfully complete the course are as follows:
- Computer: Pentium-class PC with 1.7 GHz processor or better
- CDROM Drive: (internal or external)
- RAM: 1GB min for 32bit; 2GB min for 64bit OS
- Operating System: Windows Vista, 7, 8/8.1 or 10, MAC OS X
- High-Speed Internet
- Internet Explorer (9 or higher), latest versions of Mozilla Firefox and Google Chrome
- Windows users: Microsoft PowerPoint viewer (free) or full Microsoft PowerPoint
- MAC users: Apple Keynote or PowerPoint for MAC and Windows Media Components for Quicktime (Flip4Mac Standard)
- Adobe Reader or equivalent PDF reader
Q: What is the Difference between Billing and Coding?
The job of a Medical Billing and Coding Specialist is to read your chart, match up what was wrong with you with its corresponding numerical code from the most current ICD-10 book, and then assigns the proper diagnosis code with its numerical code from the CPT 4 book. Those two codes and any modifier codes that may need to be used to better describe your problem and its treatment are then placed onto a patient encounter form or superbill.
This patient encounter form or superbill is then given to a Medical Biller or Medical Billing Specialist, as they are known as in the industry, The Medical Biller or Medical Billing Specialist then inputs the information provided by the Medical Coder into whatever software package is used by the practice exactly as it is written. That information is recorded onto either a CMS 1500, UB-04, or ADA form. The information is then either electronically submitted directly to the patient’s insurance carrier, sent directly to an electronic clearinghouse and when neither of those options is available the form is printed out and mailed to the appropriate insurance carrier. If there is no software program available the claim will be handwritten onto a CMS 1500, UB 04, or ADA form and mailed to the appropriate insurance company for processing.
However, a medical billing specialist’s responsibility does not end there. Once the information is submitted the medical billing specialist then has to follow-up on each and every claim to make sure that it is paid. Sometimes that can be a burden because they have to spend a lot of time on the phone with insurance carriers trying to get information about specific claims that come back rejected or denied. They have to deal with patients throughout the day that have concerns about their bills. They have to deal with the accounts receivable process where the insurance company sends back the physician’s payment and explanation of benefits (EOB’s) for posting into their software. They have to deal with verifying the status of the patient’s insurance coverage. The biller has to create patient invoices for any money you may owe the practice for co-pays, co-insurances, and any non-covered services. A medical billing specialist has to deal with denied claims and adjustments to a claim by filing appeals to the correct insurance carrier by getting the necessary paperwork needed to get the claim paid and resubmit them to the proper carrier. They have to run reports for their employers and be able to explain any of the discrepancies that are found and have a plan in place to correct the problems in a timely manner.
Medical Billing / Coding Instructor
Debra is our online instructor for our Billing and Coding Programs. She has over 30 years of experience in the healthcare industry, starting as a medical transcriptionist/receptionist and working her way up to Director of Patient Accounts/Business Services for one of the largest health centers in the United States. In 2006, Debra started on the career path of teaching and has been hooked ever since. She has experience teaching both in the classroom and online.
Debra is a certified coder (CCS-P) through AHIMA since 2000. She received a Masters of Public Administration in 2009 through Suffolk University in Boston, MA
Debra lives in Groveland, MA which is in the northeast corner of Massachusetts (close to the beaches and New Hampshire). She has two grown children and two grandchildren. She enjoys spending time with her grandchildren. Debra’s favorite hobby is going to the barn with her grandchildren and spending time with their horse and pony.
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