Have you always dreamed of working in the medical field? Are you looking for an occupation where you can make a consistent, reliable income and where there are going to be plenty of job prospects opening up in the future? Want to work in a clinic or hospital, but don’t have the time or money to invest in a long educational path to become a doctor? Interested in working with medical professionals, but not practicing medicine on patients? If you answered “yes” to some or all of these questions, you may be a perfect candidate for a job in medical billing or coding.
A lot of people who are new to the medical field confuse medical billing and coding, or even assume that they are the same thing, or both are just aspects of a single job position. In reality, these are two distinct positions with different responsibilities. So why do you always hear about medical billing and coding as if they were interchangeable? Probably because they are so closely related. Medical coders pave the way for medical billers to do their jobs, and medical billers and coders each need knowledge of each others’ professions in order to fulfill their responsibilities.
In a medical setting, doctors, insurance providers, and others all need a way they can communicate simply and objectively about different medical treatments and conditions. The easiest way to do this is to classify all conditions and procedures according to alphanumeric codes. There are thousands and thousands of these codes. The job of a medical coder is to become fluent in this language of alphanumeric codes and to be able to translate in and out of these codes. There are several different types of codes which are used, including CPT® codes, ICD-9 codes and HCPCS codes. If you become a medical biller, you will also be learning about these codes.
Medical billing has an obvious purpose. For doctors and other healthcare providers to get paid, bills have to be sent out to insurance companies and patients as needed. In order to bill patients and insurance companies properly, those same alphanumeric codes that medical coders specialize in need to be used. That ensures that everyone is on the same page about all of the charges and that different procedures are being charged appropriately, and various diagnoses result in the correct insurance rates being applied.
Unlike medical coding, medical billing has a customer service angle. Medical coders usually are in the backdrop, not interacting directly with customers. Medical billers, on the other hand, do work with the public, usually over the phone, sometimes at the front desk in person. There are often issues and complications when it comes to resolving billing and who is going to pay for what procedures and how much. Medical billers have to be problem solvers, helping to iron out these details and come up with a fair plan for everybody involved. Sometimes medical billers have to set up payment plans so that patients can afford to pay for their care over a longer time period.
Do medical billers ever work as coders and vice versa? From time to time, this does happen. You might start out as a coder and end up becoming a biller or the other way around if you decided you were interested in a change of pace or occupation, but you would need to make sure you got the appropriate certification later if you switched. There are also medical workers who choose to learn both billing and coding, get both certifications, and perform both job functions. The main reason you would do that is probably because you are either the sole biller and coder for a small private practice or because you are a contractor who will be providing your services to a number of clients.
Why choose to go into medical billing and coding instead of another profession in the medical field? There are a number of substantial benefits to choosing either of these as your occupation. They may not be the highest-paying medical jobs out there, but they offer you convenience, reliability, and opportunity.
An education in medical billing or coding is affordable and brief. Instead of spending years in medical school and tens or even hundreds of thousands of dollars getting ready to work in the medical field, you can spend a couple of years or less getting a certification in billing or coding. You may be able to finish up in under a year. The more time you have available to study, the faster your education will be. Even if you have a busy schedule and a full-time job, though, you can get through your coursework relatively quickly and affordably.
First, you need to ask yourself whether you want to become a medical coder or a medical biller. Do some more in-depth research or read some of the other articles on our site to learn more about the job descriptions for each one, and the personal traits and qualities that can help you to excel in either field. In general, if customer service interests you, you may be more interested in the billing end of things. If you prefer a job in the backdrop, working mainly with other medical personnel, you may prefer to be a medical coder. Or, you might plan to become a private contractor providing one or the other service or even both services to various clinics. Or perhaps you are interested in pursuing both so that you can work at a smaller clinic which can only afford to hire one person for both jobs.
If you plan to become a medical coder, you need to take and pass the CPC exam in order to earn your certification as a Certified Professional Coder, or CPC®. The organization that administers this certification is called the AAPC, and it currently has more than 120,000 medical professionals in its ranks. As you embark on your new career path, you may be interested in exploring a more specific path. The AAPC also provides specialized niche certifications. The CPC® is the most common certification for working with physicians, but you can also get the CPC-H® hospital outpatient facility certification, the payer perspective coding (CPC-P®) certification, or the interventional radiology cardiovascular coding (CIRCC™) certification. Others include medical auditing (CPMA™), medical compliance (CPCO™), and practice management (CPPM™).
At an even more specific level, you can focus on cardiology, chiropractic care, general surgery, rheumatology, pediatrics, internal medicine, urology, anesthesia and pain management, ambulatory surgical care, and more than a dozen other specializations. Getting a specialization can help you to focus your talents and potentially command a higher salary than you might with only a general CPC® certification.
What if you want to become a medical biller instead? This is yet another certification that is offered by AAPC. Becoming a Certified Professional Biller (CPB™) requires that you take the official CPB™ examination. You’ll learn the basics of medical coding, but you’ll also become familiar with different types of commercial insurance as well as government programs like Medicare, Medigap, and Medicaid. Billing regulations, HIPAA & Compliance, reimbursement and collections, billing procedures, and case analysis are all topics which are covered by the examination.
The AAPC’s website is another excellent starting point for becoming a certified professional coder or biller. On their website you will find detailed information on both of the exams (which each take about five hours to complete), and you can learn about the costs, the materials which will be covered in detail, and also receive some guidance on finding a school and choosing a course which will prepare you adequately for the exam. We’ll teach you even more about certification and schools in our corresponding sections of our website.
How do you know if you’re the right person to do medical billing or coding? Ask yourself whether you have the following characteristics:
The ideal medical biller or coder will have the level of concentration required to keep track of large amounts of information, and will be a well-organized individual. But it is equally important to want to help others. Anyone who works in the medical industry should have as their primary goal the well being of patients. This is particularly important if you plan to become a medical biller, since patients will be counting on you to treat them fairly and help them to find amenable solutions to problems involving payments.