Medical Billing and Coding W/ Electronic Health Records (EHR) 3 in-demand and recognized Certifications


What is Medical Billing & Coding?

Medical billing is the process of submitting and following up on claims with health insurance companies in order to receive payment for services rendered by a healthcare provider. Medical billing translates a healthcare service into a billing claim. The responsibility of the medical biller in a healthcare facility is to follow the claim to ensure the practice receives reimbursement for the work the providers perform. A knowledgeable biller can optimize revenue performance for the practice.

Is Medical Coding the Same as Medical Billing?

No. The main responsibility of a medical coder is to review clinical statements and assign standard codes using CPT®ICD-10-CM, and HCPCS Level II classification systems. Medical billers, on the other hand, process and follow up on claims sent to health insurance companies for reimbursement of services rendered by a healthcare provider. The medical coder and medical biller may be the same person or may work with each other to ensure invoices are paid properly. To better understand what a coding transaction looks like, read the article “What Does a Medical Coder Do?

What Do Medical Billers and Coders Do?

Medical billing and coding specialists are largely responsible for making sure medical office revenue cycles run smoothly. When a service is performed, a medical coder assigns codes to the services rendered. The diagnoses and procedure codes are taken from medical record documentation, such as transcription of physician’s notes, laboratory and radiologic results, etc.

Although a medical biller’s duties vary with the size of the work facility, the biller typically assembles all data concerning the bill. This can include charge entry, claims transmission, payment posting, insurance follow-up, and patient follow-up.

Medical billers regularly communicate with physicians and other healthcare professionals to clarify diagnoses or to obtain additional information. The medical biller must understand how to read the medical record and, like the medical coder, be familiar with CPT®, HCPCS Level II and ICD-10-CM codes.

How Much Do Medical Billers Earn?

A medical biller’s earning potential varies depending on where they live, work, how much they work, education, certifications, and experience. AAPC conducts an annual salary survey where you can learn more about medical coding salary trends. The average AAPC medical biller earns over $61,000 annually.

What is the Occupational Outlook for Medical Billers?

The 2012-2013 edition of the Occupational Outlook Handbook, published by the U.S. Department of Labor, estimated industry employment is projected to grow by 21% by 2020. In addition, they project high demand for coding services as the healthcare industry continues to grow and the country’s population ages in addition to the increasing number of tests, treatments, and procedures.

How Do I Become a Medical Biller?

The training provides the most up-to-date information relating to the health insurance industry and different reimbursement methodologies for correct claim submission. Successful completion of AAPC training prepares you to sit for the certified professional biller (CPB) exam and work in a medical billing department at a physician’s office, clinic, facility, other healthcare entity, or as a claims examiner for insurance carriers. Prepare for your certification and career in medical

Why is Medical Billing Training and Certification Important?

The financial health of a practice largely depends on the performance of the billing office. Increasing demands on providers with decreasing reimbursement require healthcare offices to have highly skilled medical billers. Understanding of medical insurance, the claims process, the appeals process, and the impact on the practice’s revenue gives the medical biller the tools to successfully optimize and maximize a practice’s revenue performance.

Skills of a Medical Biller

  • Navigate through various insurance rules and regulations to reduce A/R days
  • Understand the nuances of various types of insurance carriers along with their claim requirements
  • Provide successful follow-up efforts for A/R including the appeals process for denied claims
  • Implement best practices for insurance and patient collections while maintaining excellent public relations
  • Reduce risk by understanding Fair Debt collection practices, professional courtesy regulations, clean claims and timely filing guidelines, refund requirements, and other regulations
  • Use data and reports as indicators for potential improvement areas

What is Medical Coding?

Medical coding is the transformation of healthcare diagnosis, procedures, medical services, and equipment into universal medical alphanumeric codes. The diagnoses and procedure codes are taken from medical record documentation, such as transcription of physician’s notes, laboratory and radiologic results, etc. Medical coding professionals help ensure the codes are applied correctly during the medical billing process, which includes abstracting the information from documentation, assigning the appropriate codes, and creating a claim to be paid by insurance carriers.

Medical coding happens every time you see a healthcare provider. The healthcare provider reviews your complaint and medical history makes an expert assessment of what’s wrong and how to treat you and documents your visit. That documentation is not only the patient’s ongoing record, but it’s also how the healthcare provider gets paid.

Medical codes translate that documentation into standardized codes that tell payers the following:

  • Patient’s diagnosis
  • Medical necessity for treatments, services, or supplies the patient received
  • Treatments, services, and supplies provided to the patient
  • Any unusual circumstances or medical condition that affected those treatments and services

Like a musician who interprets the written music and uses their instrument to produce what’s intended, Medical Coding requires the ability to understand anatomy, physiology, and details of the services, and the rules and regulations of the payers to succeed.

he Medical Coder and biller process a variety of services and claims on a daily basis. Medical codes must tell the whole story of the patient’s encounter with the physician and must be as specific as possible in capturing reimbursement for rendered services.

The main task of a Medical Coder is to review clinical statements and assign standard codes using CPT®ICD-10-CM, and HCPCS Level II classification systems. Medical billers, on the other hand, process and follow up on claims sent to health insurance companies for reimbursement of services rendered by a healthcare provider. The Medical Coder and medical biller may be the same person or may work with each other to ensure invoices are paid properly. To help promote a smooth coding and billing process, the coder checks the patient’s medical record (i.e., the transcription of the doctor’s notes, ordered laboratory tests, requested imaging studies, and other sources) to verify the work that was done. Both work together to avoid insurance payment denials.