Medical Coding and Billing


Medical coding is among the most in demand professions in the USA and around the world. If you ever had, and still have an interest in the industry of healthcare then the best time to get started is NOW.

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What is a Medical Coder?

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

There currently 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 medical services, medications 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 by abstracting coded information from the patient's medical record into the financial system for billing...

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Where Medical Coders Work

Every time a doctor, clinician, practitioner, licensed nursing staff and allied health professionals provides medical services, treatment and advice to patients and clients billable services incur. Since doctors, nurses, and other allied health professionals don't have the expertise to deal with health insurance regulations and reimbursement rules, clearing houses and medical services reimbursement claims they call on the knowledge of medical coders to get the process going. Almost all doctors, medical practices and establishments outsource the task of medical coding and billing process and place this crucial task into competent hands. Medical coding specialists and supportive staff are utilized by hospitals, clinics, doctor's single- and group practices, health maintenance organizations (HMOs), mental health care facilities, insurance companies, and countless other places.

Skilled medical coding professionals are also sought by small and large medical practices, clinics, hospitals, insurance companies (Kaiser, Blue Shield, Blue cross, etc.) and consulting firms everywhere. Thousands work for Humana Inc., which is headquartered in Louisville, Kentucky, and one of the nation's largest publicly traded health benefits companies. Humana offers a diversified portfolio of health insurance products and related services to employer groups, government-sponsored plans, and individuals. Kaiser Permanente's Kaiser Foundation Health Plan, a nonprofit corporation that enrolls individual and group members and arranges their health care benefits; and Kaiser Foundation Hospitals, a nonprofit corporation which contracts with Health Plan to provide all hospital services required to meet members' needs is another large, nationwide employer of many medical coders and claims analysts (to name just a few). They are also hired by branches of the US Military to support health care systems for veterans, soldiers and their dependents.

Correct medical coding is crucial in getting paid for medical services provided, otherwise, when a claim is not properly filed, submitted, and processed it leads to denials, which means financial losses for the provider. Naturally a business cannot prosper and run on losses. When medical coding firms or doctors outsource their medical coding and billing it is critical to the business to choose an individual or company which 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.

Claims may be paper claims or electronic claims. The medical biller verifies that all codes are properly matched with medical diagnoses, procedures and medical devices involved and submits them to the responsible party (payer), using the insurance information that was provided. The patient's health insurance then verifies these claims and reimburses the provider for billable services as agreed. Patients will then be billed for any outstanding co-payments, remaining co-insurance portions and services not covered by insurance.

Medical Coding from Home

There are many forums and message boards on the Web loaded with people asking about the possibilities of coding jobs from home. We have done our own research on major job sites on the Internet and came across a handful classified ads for medical coding jobs that can be done remotely. Therefore we know, the possibility exists, however, we also noticed that the select few employers have very high expectations and stringent rules and typically expect certified credentials, years of experience, letters of recommendation from previous jobs, diplomas and degrees, or other qualifications before they grant the job.

  1. Medical Coders Daily Grind
  2. Medical Coder's Training Requirements
  3. Medical Coder Workplace
  4. Medical Coding Future Professional Outlook