Medical billing and coding schools can be found through vocational schools, technical schools, online universities and community colleges.  These medical billing and coding schools will teach students how to organize and collect a patient’s medical information for billing purposes.  Those that have graduated from a certificate or degree program will earn the education and training that will qualify them for entry level positions as a medical coder.

How to Get Started in this Field

Some medical facilities in the past have hired employees for the medical billing position and offered on the job training. These days an employer will not even look at an applicant’s resume unless they have completed a certificate or degree program.  The certificate or diploma programs that are available can take four to eighteen months to complete and will teach coursework in general education, anatomy, physiology, medical terminology, ICD9 coding basics, advanced coding, medical law and ethics, encoding procedures, diagnostic procedure coding, coding software applications, information systems, pharmacology and medical coding.

To qualify for one of these programs the student will need to have their high school diploma or GED. Some medical billing and coding schools will require applicants to have basic computer experience and a background in medical terminology. A student may also be required to obtain liability insurance and undergo health testing before being accepted into a program.

The medical biller can work in private medical practices, hospitals, nursing homes and different types of out-patient facilities.  Those that have graduated from a program can qualify for entry-level positions such as insurance specialist, medical transcriptionist, billing and scheduling coordinator, medical administrative assistant and patient account rep.

The Degree Programs Available in this Field

The medical coding specialist two year associate’s program includes an education in coding, medical topics and computers.  Those that graduate from a degree program can meet eligibility requirements for professional certifications and advanced job opportunities.  During this type of program you will also work clinical hours in a professional medical setting, learning hands on training.

To qualify for an associate’s program the applicant will need to have their high school diploma or equivalent and can also require the completion of specific courses such as medical terminology, keyboarding and business communications.  These courses typically include courses in medical coding systems, medical diagnoses, medical treatments, pharmacology, information technology, office administration, medical leadership and advanced encoding.

Employers will require thirty six hours of continuing educational training and certification through the AAPC.  Those medical billing specialists need to renew their licensure every two years. These health care professionals need to apply for re-certification six weeks prior to license expiration.

The cost for certificate programs can range from 2,500$ to 4,000$, while the associate’s degree program can range from 3,500 to 5,000 each year.

While medical billing and coding certification is not state required in order to enter the profession, earning the medical billing and coding certification will provide you with the basic credentials that a potential employer will want for entry-level positions.  To earn certification as a billing specialist you will need to complete a certificate or degree program and take the exam through professional associations such as the AHIMA or the AAPC.

The Significance of Certification

Although it isn’t necessary to obtain certification to land employment in this field, it will greatly increase your chances of landing a job.  The employer will prefer an applicant who can provide proof that they have specific knowledge and skills that are crucial to working in this part of the health care field.

While a medical biller is not required to earn a degree prior to taking the certification exam, the programs are designed to not only provide hands on experience through clinical work in a medical setting, but they also cover extensive courses that train students on the material that’s covered in the certification exam. By having completed a certificate program or obtained a degree, you will show a potential employer that you possess a broader knowledge of the field in comparison to those applicants that have no formal training.

Coursework for Certification Programs

When choosing an accredited program, you should look for one that teaches basic and advanced courses in coding and features up-to-date billing and coding software program training. A course will teach students how to use the international classification of diseases manual, also referred to as the ICD9 coding book. This manual is periodically updated to incorporate advances in medical procedures. A new manual is scheduled to be released in the next year so students should find a program that teaches coding procedures for both the ICD9 and the ICD10.   This type of program will give the student an advantage over those that have no formal training for the newer procedure manual.

The AAPC, AHIMA and the AMBA can offer the best medical billing and coding accredited programs that offer both certificate and associate programs online or in-class.

The certification exam will consist of 200 multiple choice questions, with students having two hours to complete the test. Should a student fail to pass the exam they will have a chance to retake it within a year’s time, free of charge. To maintain licensure the medical billing specialist will be required to earn a total of thirty six hours of continuing education credits to qualify for certification renewal every two years.   CE credits can be earned by enrolling in an online or in-class study course or by taking AAPC approved exams through their website.

As a medical biller, you will work in hospitals or other types of medical facilities, obtaining payment from insurance companies. The medical biller determines which procedure was performed on a patient and then sends out the billing invoice to the insurance carrier. This is a two part job that involves applying a code that represents the treatment and medications that were received by the patient, then submitting important information to the patient’s health insurance carrier and following up with the insurance provider to have the services reimbursed.

Billing Specialist Career Information

The billing specialist will use the patient’s records in order to determine what they should charge the health insurance company for services that were provided. The medical coder will also enter patient information into the medical facilities database in order to keep track of which medical procedures were administered.  Coders also calculate expenses for services and will then prepare a list for medical billing statements and medical insurance invoices. A billing specialist will also need to submit additional patient information should the insurance company deny the claim.

Medical specialist are not required by law to have completed a formal training program in order to work in this field, but the completion of a certificate or degree program will be required by most employers.  Coursework included in a certificate program will involve classes in medical billing software, medical terminology, medical billing software and medical law and ethics.

These programs will also teach beginner and advanced medical coding courses. Medical coding involves assigning codes for medical procedures using different types of coding reference books. Codes are assigned for different medical procedures, for example, if a patient has a car accident and suffers a broken right arm, ribs and a broken left leg. There will be a special code for the left leg, car accident, etc. should a coder assign the wrong codes the insurance provider can deny coverage.

To determine the reimbursement rates the coder will use assigned procedure codes. The billing specialist will also review a patient’s chart, writing down the appropriate codes that will need to be entered into the medical facilities system. Some medical coders are both coders and billers but this can vary depending on the facility in which they work.

The Difference between Medical Billing and Medical Coding

When it comes to the job description for the medical coder, they are responsible for reading notes written by the physician in order to identify procedures and the medications that were administered, following up with a physician as needed in order to clarify the services that were provided and applying the correct codes to the information that was provided by the patient in addition to the diagnosis and treatment by using different coding systems such as the HCPCS, CPT and the ICD9.

The biller will act as the link between the health care provider, insurance company and the patient. They’re responsible for taking the coded information from a patient’s visit to a medical facility and preparing and submitting a claim to the proper source. They also work by following up with claims and will make contact with insurance carriers until reimbursement has been received. As a biller you will need to have a strong knowledge of the different types of insurance providers and you’ll also need to be familiar with regulations and different billing processes. This can include Tricare, commercial claims, blue shield, Medicare, blue cross, Medicaid and workers compensation.  A biller will handle varieties of administrative tasks, with the main purpose being to handle insurance processing for all medical care services, procedures, consultations and medications.

If you’ve asked the question “what is medical coding?” and would like to know more about the career, here we’ll talk about their job description, education requirements and the difference between medical coding and medical billing. We’ll also learn more about the coding manuals used in the field and the education options available. Every time health care is provided in a hospital, physician’s office or other type of medical facility, the physician will be required to document the services that were provided. The biller will work by using the information from the provided documentation and assign a code, creating a claim that needs to be paid by the patient or their insurance provider.

How Medical Coding Differs From Medical Billing

The medical coder and biller might be the same person or they will work closely together in order to make sure billing invoices are paid properly. The coder is responsible for assigning the correct codes on a claim.  To accomplish this, a coder has to check different sources in the patient’s medical record so they can verify the services that were provided.  A coder assigns ICD9 codes, CPT codes or HCPCS codes to report procedures that have been performed and in order to provide the biller with the required information to process the claim in order to reimburse services provided.

The Medical Coder Responsibilities

As a coder you will need to have a thorough understanding of medical terminology and anatomy. It’s also important to be familiar with the different types of insurance providers and their plans and regulations. Coders use resource books such as the HCPCS, ICD9 and the CPT, assigning correct codes in order to record the service levels of the services provided and so they can account for the supplies that were used to treat the patient during a session with a physician. The codes used for the procedure should correspond with the physicians diagnosis and medications administered or treatments performed during the session.  

In addition to assigning codes the coder can also be involved in different coding related activities. They can audit or re-file appeals for claims that have been denied or they can educate providers, recommending appropriate application of federal mandates that will require a provider to use specific billing and coding standards through auditing charts.  They can also act as an advocate for an insurance provider and patient for issues such of coverage and medical necessity.

As a coding professional you can strengthen your career by obtaining your bachelor’s degree or master’s degree, neither of which is required for a career in coding. A solid understanding of physiology, medical terminology and anatomy are required.

There are also certificate programs that can be completed in one to two years or the associate’s degree that can be completed in two years. These programs can help prepare the student for taking the certified professional coder exam in order to gain licensure as a coder. Having certification as a coder will assist you in landing a job quickly as certified coders are in high demand due to employers knowing these individuals can perform their job with upmost proficiency. Now that you’ve learned the answers to ‘What is medical coding?” you can get started on earning your education for this health care field.

Medical billing and coding online schools offer certificate or associate degree programs that can take one to two years to complete. You can find programs that are accredited through AAPC through online universities such as the University of Phoenix, Kaplan University of Everest College. These online colleges feature low monthly payment plans of 65$ a month for a total of two years.

How Online Programs Work

You can sign up for a program online and will need to meet the minimum requirements of a high school diploma or GED. To begin your education you will need to wait one to two weeks for the ICD9 manual and other study materials to arrive in the mail. Once you’ve received these materials you can begin right away by logging onto the schools website, checking the syllabus and finding out which section to begin with. After you have completed each section you’re required to take a section exam. This is done from the study manual with the student filling out answer sheets that are provided by the school. The student will then need to mail in the completed test sheet and can expect to see test results online within a week. For final exams, this is done online and open book. The study materials included involve the ICD9 manual, anatomy flashcards, a medical coding software program, test sheets and a study guide for the assigned section.  

You can go at your own pace to complete one of these programs, however, some schools will give the student a sixty day requirement per section and will charge a fee should the student turn their work in late.

After you have completed a medical billing and coding online schools program you can find local testing centers that will administer certification exams, through your online school.

Required Continuing Education Courses and Alternatives for Medical Billers and Coders

As a CPC you will be required to earn thirty six hours of continuing education in order to qualify for license renewal every two years. To earn these required hours you can enroll in online courses through the university you’ve graduated from and receive a significant discount or they may even offer free exams or classes that will count towards the required hours.

To earn hours a professional can choose to take the online training courses or they can attend conferences or workshops related to the medical coding and billing profession.  Specific guidelines for the required amount of hours can differ depending on which organization you go through to obtain your certification.  To count towards the mandatory hours the hours of continuing education will need to be relevant towards the specific credentials that are being maintained. When the CPC attends lectures, seminars and workshops they will need to have signed proof of attendance.

Certificate programs for those interested in working in the billing and coding field will includes a one year program that can be found through vocational schools, online universities or community colleges. The medical coding classes included can vary depending on the institution and the billing and coding organization they are accredited by. Here we will take a look at the medical billing and coding classes involved and the clinical programs offered.

Core Classes for the Medical Coder for Certificate Programs

These certificate programs will provide a student with the overall understanding of the duties they can expect to perform when working in a medical facility. The student will learn how to schedule appointments, transcribe medical records and physician orders, bill patients and how to correspond with medical personnel and insurance companies.

Classes offered in this type of program will cover such topics as medical procedures, terminology used in the medical field, intro to health management, ICD coding systems, basic principles of disease, anatomy, physiology, ambulatory coding systems, advanced coding systems, physician coding and professional practice experience.

In these classes the student will learn how they can transform a medical procedure and treatments provided into shorthand code that is used to communicate with insurance carriers for record keeping and billing purposes. They will also learn about different coding technologies, keyboarding and software programs commonly used in this field. These programs are designed to prepare the student for entry level positions in a variety of medical facilities and will also prepare the student to take the certified professional coder exam once the program has been completed.

How These Programs Work: How to Know They’re Accredited

You can choose to enroll in an online program, in-class program or a blended program.  There are several online programs for medical billing available; however, the student will need to ensure the program is accredited by the AAPC prior to making an academic commitment. Some of these programs will advertise these classes as a way to interest individuals that want to work from home. Ten years ago it was common for medical billers and coders to work from a home office, however these days it’s almost impossible to find a medical facility that will hire off site coders.

Be wary of coder courses that focus their program advertisement as a way to be self-employed, these schools usually do not offer accredited AAPC programs, meaning you could waste a couple of thousand dollars on an education that will not qualify you for the field.

An easy way to ensure a program teaches an approved coding course is to check the AAPC’s website where you’ll find listings of accredited programs by state or learning institution.

A medical coding specialist will review and read medical documentation that’s provided by doctors or other health care professionals in order to learn detailed information regarding their injury, disease, medical procedures and surgical operations.  The detailed information is then translated into a code used from manuals such as the ICD9.

Specialist Work Environment

Using a coding manual the medical coder specialist will need to be sure to use correct code selections for compliance with the insurance carriers and federal regulation requirements. The medical codes used are for reimbursement purposes for the medical facility’s and physician’s claims for Medicaid and Medicare insurance payments.  The information that’s gathered by the coder is used in order to prepare statistical reports that are used by hospital administrators for marketing, planning and other management purposes. State and federal governments will also use this type of information in order to identify health care concerns that are critical to the public as a whole. Coders will need to know about the medical and business side of health care is essential in this field of health information management.  

A specialist will work in surgery centers, hospitals, clinics, home health care agencies, consulting firms, dental offices, government agencies and long term care facilities.  A specialist will typically work under the supervision of the chief financial officer or the health information manager.

Education Requirements for the Specialist Field
Students those students that are interested in a career in the medical coding field will need to take courses in high school for biology, algebra, data processing, English, computer skills, and typing. After graduating high school the student can enroll in a certificate program or enroll in an associate’s degree program.  To earn certification you will need to pass the exam that’s offered by the American Health Information Management Association of the AAPC, also known as the American Academy of Professional Coders.

The majority of specialists will work in an office building or in the back administrative offices of a hospital or other type of medical facilities. The coding specialist will spend several hours analyzing coding patient’s charts. They will also devote a significant amount of time on their computers working with medical coding software programs, electronic health records and other types of applications. In order to resolve diagnostic questions the coding specialist will use codebooks like the ICD9 or the ICD10. A coder will primarily work by themselves but may need to clarify services provided with the attending physician or supervisor. The specialist will work full-time at forty to fifty hours a week. When working in an in-patient setting the specialist will sometimes work evenings and overnight shifts.

Certification for this profession is voluntary but is worth pursuing.  Applicants with AAPC or AHIMA credentials are highly preferred by potential employers and will typically earn more than those that have no certification. The APPC estimates that specialists who hold certification as a coding specialist can earn 30% more than those that have no certification. This type of AAPC certification will also require a mandatory amount of CEC.