Medical Coding's Code-Pendency With Medical Billing

What is a Medical Coder?

A medical coder is not a medical biller, but medical coders need basic medical billing knowledge to competently and efficiently do their job, since both disciplines are so closely related and code-pendent (pun!)

There are over 819,000 physicians and surgeons; 2.4 million registered nurses, 77,000 occupational therapists, 182,000 physical therapists, 94,000 respiratory therapists and a plethora of other allied health professionals in the USA alone. Naturally they ALL want to get paid for their medical services and supplies provided to the public. This is where the medical coder comes into play! The medical coder gets the ball rolling by initiating the reimbursement process. The process begins by abstracting coded information from the patient's medical record into the financial system for billing. 

Correct medical coding is just as crucial as correct medical billing in getting paid for services provided, otherwise, when ever a claim is not properly coded, filed, submitted, and processed it leads to denials, and this means losses for the provider. Naturally a professional business cannot prosper on losses. When medical coding firms or doctors outsource their medical coding and billing it is critical to assure the chosen individual or company is well versed in the latest coding standards and follows AHA, UHDDS, HCFA and HCHS coding guidelines, latest medical billing criteria, and uses clearinghouses to get the job done in an efficient manner.

Medical coders and well as medical billers must have the ability to read and understand handwritten physician notes and documentation and a working knowledge of at least one patient management system, along with familiarity with electronic medical records and ability to discuss and resolve claims issues with clinic staff and patients.

The close relationship between medical coding and billing is undeniable and inescapable! While they are well respected and highly regarded they often face adversities from insurance companies, such as inappropriate denials, poor payments and other obstacles and disservices to the doctors and patients that the must resolve working hand in hand with each other to coordinate their efforts. Their mutual goal is to meet patient and health insurance billing needs of doctors, clinics, hospitals, home health care service agencies, and similar businesses in the health care network. Although regarded as two different disciplines, medical coding and billing professionals work hand-in-hand to assure health care providers get paid for all procedures and materials rendered.

When Coding—Remember You are NOT the Doctor—And Don't Blindly Trust the Software

Steve Verno, a seasoned and experienced certified medical biller has shared the following with us today:

"I've seen the following scenario at least 5 times this morning."

Scenario:

"Someone sends me a message along the lines:

My doctor performed XXXXX and he diagnosed the patient with 000.00.  The insurance company, ABC, denied the claim saying 000.00 cannot be used with XXXXX.  I use XYZ Software to code and it says if we want to use XXXXX, it needs 999.99 as a diagnosis.   The doctor will not change the diagnosis to 999.99.  Is there another diagnosis I can use to get XXXXX paid or is there a procedure I can use with 000.00?

When we code, we must always refer to the doctors documentation of the service (procedure) rendered and the diagnosis documented by the doctor.  We cannot and should never code based on the lack of observing documentation.  While software is nice, the software may have been created by an insurance company and it may be biased towards that insurance company's internal coding policies.  There have been lawsuits regarding an insurance company's software where the courts have found that the software was biased for the insurance company.  While software may be a nice adjunct, it can never replace good old fashion brain matter where we open the coding book and use our coding training to look up a correct code. 

In medical coding, a diagnosis is always selected by the doctor.  We are not doctors and we cannot make up a diagnosis just to get a claim paid. We, as coders, take the doctors diagnosis and convert that diagnosis to a code we submit on a claim.  Medical coders never diagnose. There are rules to follow.

If those rules result in a claim denial, then we may have no resolution, but we can never take shortcuts or look for loopholes or make up anything to get a claim paid.  We can never code without reviewing the medical record documentation.  Our commitment is to prevent and never accept or allow fraud or abuse." (Steve Verno, Certified Medical Biller).

To read more real-life anecdotes and medical billing tips from Steve and others visit our Medical Billing Community forum.
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Medical Coding and Billing Career Guide Web Site Redesigned

We have completely redesigned the Medical Coding and Billing Career Guide website. It has a brand new "face", i.e. new template and its layout is much easier to navigate via the navigation panel near the top.

Explore Medical Coding—Discover Opportunities

When deciding on a career path you must first understand your talents and take your interests and past experience into consideration. Past experiences, whether on and off the job, should always play a key factor in the decision making process, as usually it is through them that you know what you like and dislike, and what you can, and cannot (will not) do.

Many of the top "in demaand occupations" with countless opportunities for men and women alike are in the healthcare and allied health professions. However, although wide open, in generally speaking, the more education you have, the higher your wages will be.

One well compensated career in the healthcare industry is that of the medical coding and billing professional, but especially medical coders! The demand for medical coding experts has never diminished; or in other words, the need for their skills and talents remains high. Doctors and nurses depend on medical coders and their skills.

Medical coders, although they do not provide direct (hands-on) patient care are an important part of the healthcare system and medical office team.

Medical Coders - We Want You To Know...

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Which Healthcare Occupation is Right For You?

So, you want to enter into the medical and healthcare field, but becoming a doctor or nurse isn't quite what you had in mind? Then here are good news.... there is a plethora of careers one can choose from in the healthcare industry and each one is hot, hot, hot!


Something For Everybody!
Do you like working side-by-side with medical and healthcare professionals? Do you like helping people that are ill or need medical care? And even if you aren't exactly a hands-on people person, there still is room for you in heathcare!!! This field is so vast and complex that there is room for everybody's talents, whether it may be in the clinical or administrative areas. Everybody is needed and many get a chance to land their dream job.


Indeed You have Choices!
Choices are a blessing; and it is nice to know there are so many different career options in the healthcare field. Health career opportunities are available as first time professions as well as many second and third career choices, full or part-time. Medical offices, clinics, and hospitals need medical coding and billing staff, as well as all other helathcare professionals MORE than EVER.


Not Just Doctors and Nurses!
Health field career entry level opportunities include such jobs as:

• medical assistants


• medical office receptionists


• medical records clerk


• medical data assistants


• medical coding and billing specialists


• medical transcriptionist


• personal care aides


• certified nursing assistants


• physical therapy aides


• dental assistants


• pharmacy aides


• and veterinary assistants

Technical fields that require additional special training include:

• lab technicians
  
• X-ray technicians
  
• CAT and MRI technologists
  
• ultrasound technicians
  
• pharmacy technicians
  
• hemodialysis technician
  
• prosthetic technologist
• dosimetrist and sonographer
  
• and radiation therapists

Behind the scenes and other jobs that don't require direct patient care include:

• medical writers


• medical illustrators


• medical photographers


• medical librarians


• medical interpreters/translators

Furthermore, health insurance companies provide additional opportunities for healthcare professionals including case management, medical reviews and medical authorizations. The U.S. Department Bureau of Labor Statistics outlines many of the career opportunities in the health care industry. You can read more about the medical coding and billing career here.

Choosing the Right Medical Coding & Billing Training Program

Choosing a medical coding and billing program that leads to the right outcome demands prior research. Here is a checklist of what you can do and ask when choosing an online course:

Get in touch with the provider of the vocational training program or online course and ask questions about the course requirements:

Ask if the program is composed, managed, and taught by experienced (and certified) medical assistant professionals and instructors, who have actually worked in various disciplines of the medical assistant field.

Review the program syllabus. The training should be comprehensive and cover all aspects of the medical medical coding and billing occupation.

Find out the program's success and pass-rate: the percentage of students that graduate successfully from the program, sit for certification exams, and land jobs.

Ask to see the program's refund policy. If they don't have one, it's best to walk!

Choose only courses that meet your specific educational needs and goals, if a program is not flexible enough, or does not lead to the desired credentials, it's probably not for you.

Contact leading professional associations and certification bodies and ask about their guidelines so you know whether you will be eligible to sit for their professional certification exam upon graduation.

Check the school's recognitions and accreditation status. Also, if it is an online course, remember to check their reputation. A reputable school will always post all necessary info to their website. A great place to double check is the BBB Online website.

See if the website has a public forum where you can read the comments. Don't rely solely on a website's published customer feedback language, since bad customer comments can be sorted out, and good ones faked.

Examine the school's address. Is it a physical address, or does it exist only in cyberspace? With a physical address you will always know where to turn should you run into problems.
Are you signing up for local services, or services provided from abroad? You might run into legal concerns but will have trouble enforcing them if the business is registered abroad.

Ask around; seek advice from professionals already in the field, read the newspaper to find out current trends.

Know whether local employers hire graduated from this school, what documentation they want, and what the future outlook might be.

Choose what's right for you, but let the school know that you are an informed consumer that will choose wisely!

© 2007 Danni R./Advanced Medical Assistant Custom Web Design, LLC.

Professional Continuing Education for Medical Coders

One valuable commodity on the Internet is readily accessible continuing education programs for professionals. However, where nursing continuing education (CE) programs can be easily found on hundreds of nursing websites, professional continuing education programs for those in the medical coding and billing industry remain scarce.

One possible reason is that nurses were always expected to continue their education beyond the classroom to maintain their licenses, and secure their job. However, when it comes to unlicensed allied healthcare professionals, such as the medical coder, it was not expected until just recently.

Now that new state laws and rules in Medicare, HIPAA, and OIG compliance are on the rise, suddenly employers realize that having only the best staff under their employ pays off big! Now, when they hire they try to select applicants that are certified over those who are not.

This increased awareness has contributed to a new trend, where more and more medical coding and billing professionals elect to sit for medical coding and billing certification exams to get their credentials. It is an important step toward professional excellence.


RISING ABOVE THE CHALLENGE!
Being a professional means commitment to continuing one's education and to pursue practice enhancing learning. This commitment to self improvement in field-specific aspects of professional competence, such as foundational knowledge and technical skills is very important to remain competitive in the field and reach higher goals. However, obtaining enough annual contact hours to maintain professional credentials can be a challenge at times.

GET YOUR APPROVED CEU'S HERE!
12 Per Year For Only 40 Bucks!!!!

One big concern for professionals who need annual Continuing Education Units (CEU's) is lack of availability, money, and time. They often work full time and have extremely tight schedules, family obligations and limited funds which makes it difficult.

When medical billers and coders need the latest health care news and annual CEU's in an uncomplicated, straight forward environment they can always count on BC Advantage Magazine, and the Online CEU Center! Not only that... There also is an active medical billing forum designed specifically for medical billing and coding professionals. We highly recommend this invaluable resource to all our medical billers and coders.


© 2006 Advanced Medical Assistant Custom Web Design, LLC.

How to Overcome Lack of Work Experience

New Medical Coding and Billing Program Graduates:

How to Overcome Lack of Work Experience

More and more employers who hire medical billing and insurance coding staff are looking for professionals with one to two years experience in the field. New graduates find it hard to land their first job without it. They always seem to fall into the controversial "I can't get work without experience, and I can't get experience without work" rut, which is hard to escape. However...

Although this is always a challenge, there are ways to overcome lack of work experience when applying for a job. The trick is to highlight other selling points and making a good impression.

• Request an appointment with the human resource manager or nurse supervisor to learn what they are looking for. Find out if there is room for exceptions. Tell them what you can offer their facility and how great of an asset you will be.
• Try to offer your service by volunteering. Mention relevant skills you have, such as your accomplishments while you were in school, or college; include scholastic awards and --most importantly: mention your externship! Time spent in a medical office in form of the externship is work experience.
• Never arrive empty handed. Be prepared to mention how satisfied your former employers, field supervisors, clients, andinstructorss were, supported by as many letters of recommendation that you can get.
• Anyone attending a job fair should bring several copies of a well written resume, dress professionally, and be prepared for on-the-spot interviews.
• Southern University Career Services Baton Rouge, Louisiana suggests the following dos and don'ts for women dressing for an interview:
  
  1. Dress in a simple and clean manner.
  2. Select clothing appropriate for the job you are interviewing for.
  3. Wear natural colored hose.
  4. Wear plain shoes with closed heels and toes.
  
  
  Those who do not have a business attire should select clothing appropriate for the job such as crisp clean scrubs, along with a name tag, professional badge, and sparkling white nurse's shoes.
  
• Discuss other valuable skills you've under your belt, such as those acquired through activities in community groups, volunteer work, or even personal interests. Don't forget courses, workshops, or seminars taken outside the medical assisting profession, for example in sales, interpersonal communication, languages, customer services, data entry, computer applications, and word-processing.

All this can help to convince a new employer, that although you may not have the requested amount of work experience in your new role as a medical assistant, you are certainly worth their attention and consideration for the job.

© 2005 Advanced Medical Assistant Custom Web Design, LLC. All rights reserved.