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Medical Billing & Coding Training Facts

By: CareerFactsheet editors- Updated: Jul 30, 2012

If you are considering an administrative career in healthcare field then you may very well be considering a career in medical billing and medical coding. This is an important aspect of the administrative side of medicine and one that is enjoying an ongoing growth period. In fact according to the US Bureau of Labor Statistics the profession is expected to grow by 20% between 2008 and 2018.

Unlike many clinical careers in healthcare there are no formal national or statewide educational requirements for medical billers and medical coders, who are more commonly employed these days to perform both aspects of the job at the same time as medical billing and coding specialists. This does not mean however that getting a job without at least some degree of formal education is in any way going to be easy.

The vast majority of the employers who need the services of medical billers and medical coders prefer - and in many cases require - that the staff they hire have some formal education, whether that education comes in the form of a certification gained as a result of completing a 12 month course, an Associates Degree and even sometimes a Bachelors Degree.

Do Medical Billers and Coders Need Formal Education?

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To those who have never given much thought to the process medical billing can often seem like it is a fairly easy and straightforward job that would have no formal educational requirements at all. Why, they often think, would you ever need to go to school to fill out a simple form? There is however a lot more to medical billing and coding than simply filling out a form!

The vast majority of the educational programs at all levels for medical billing and coding cover both sides of the profession. Further on down the line a person might choose to specialize in one area or another but because the two fields overlap in so many ways having a full understanding of both is a must in the eyes of most employers.

There are also additional considerations for the medical billing and coding profession that are becoming more and more important every day. Many of these relate to both HIPAA (the Health Insurance Portability and Accountability Act) standards and to the need for medical practitioners and providers of all kinds who bill insurance companies - especially Medicare and Medicaid - to meet, and continually comply with, increased accreditation standards in order to be able to accept and bill health insurance companies at all.

What Are The Education Paths to Basic Certification?

Almost all employers now require that their medical billing and coding staff hold a minimum of a formal certification in medical billing and coding. With so much on the line when it comes to their billing and record keeping practices training someone who has no formal education "on the job" is an expense - and a risk - that most employers are simply not willing to take.

The most basic certification programs take around twelve months to complete. While every course offered by a certain school is different there are some things that they all cover that are essential for anyone who wants to become certified to learn. These include:

  • Coding Basics - A medical billing and coding certification course will cover the basics of coding - both ICD 9 coding and CPT coding - and just how a coder takes information from a patient chart and "translates" it into the right codes. Students will also learn about other variables like modifiers that can further affect just how a claim is coded correctly.
  • Basic Medical Terminology - A medical billing and coding specialist has to be able to quickly understand the medical terminology that is used in the records they will be using to get their billing information. The terminology students cover during the course will address most of the basics, although it will not need to be as in depth as a person entering the clinical side of healthcare needs to learn.
  • Regulations Issues - There are a great many regulations, set both by the health insurance companies and the government, that a medical billing and coding specialist must be familiar with and these are covered in this section of a certification course.
  • Medical Billing Practices - This section covers general medical billing practices such as information verification, filing and reconciliation practices, appeal processes and other general issues to that apply to most medical billing offices.
  • Ethics - Fraudulent medical billing is a very serious issue and it is crucial that medical billers and coders learn what constitutes fraud as it will apply to their job. Not all the billing that is considered fraudulent is actually deliberate. Certain mistakes billers and coders make can be viewed as fraud so learning how to avoid these is a must

At the end of the course students are usually given an exam that will determine whether or not they are to be granted certification. Everything they learn beforehand leads up to this test but general coursework will count for a portion of their score as well.

Where to Take Certification Courses?

Medical billing and coding certification courses are offered at community colleges, private campus based colleges and by specialist trade schools. There are also a number of online colleges that offer similar courses.

The cost of these courses can vary from around $2,500 to $5,000. Provided these schools are properly accredited students should be able to obtain any financial aid they might be eligible for in the same way as any other student of their institution is to help meet the cost of the course.

Degree Programs

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Statistically medical billers and medical coders who earn an Associates Degree in Medical Billing and Medical Coding have greater initial potential earning power than those who just hold a certification. This disparity does tend to become less relevant the more experienced a person becomes in the real world of work but from an entry level point of view a degreed medical billing and coding specialist may often have an advantage.

Degree programs - there are now some Batchelors' programs available as well as Associates - take the basics covered in a certification course and explore them in greater detail. There is very little brand new information in these courses over a certification course but they go far deeper into every aspect of the medical billing and medical coding process including how different sectors of the healthcare industry's billing practices differ.

For example the way that medical supplies are billed is rather different to the way that medical services are. Home healthcare and medical equipment supplies use an additional set of codes - called HCPCs codes - in addition to ICD-9 codes and these are rarely covered extensively in a certification course. As a degree student a person can choose to learn about them in detail though is this is an area they might be interested in working in.

Degree programs in medical billing and coding are offered by 2 and 4 year colleges both on and offline and again, provided that the school is properly accredited all the usual financial aid benefits and loan options should be available to students.

Some people do wonder which might be better for them - a medical billing and coding education undertaken at a campus based school or one pursued online. As the course material tends to be very similar it is really a matter of personal preference. For some people online schooling really is the only way they can pursue their education due to other commitments and an employer will very rarely make a distinction between credentials earned online and those earned at a physical school.

Life After Training

The career prospects for a certified medical billing and coding specialist are very good and the variety of settings they can work in is extensive. Specialist medical coders are most often employed by hospitals but those people who are willing top do both medical coding and medical billing will find that the possibilities are much wider. Where they work may depend on their "style' Some people love the hustle and bustle of a large hospital setting while others prefer the more intimate team atmosphere of a small doctor's office.

One thing that should be noted is that despite the large number of ads you will see online working from home as a medical billing and coding specialist is almost impossible for a new graduate these days. In fact the increased privacy and accreditation requirements that govern the field these days make it very difficult for even a very experienced person to do so. There are a number of medical billing services across the country but they hire physical employees to work in their offices and outsourcing to a work at home employee is very, very rare.

The ads you might see are, sadly, very often a scam to try to take people's hard earned cash. They often promise that in return for a fee they will provide lists of doctors or medical facilities that employ "at home medical billers". As too many people have found out the hard way these lists turn out to be useless.

Pursuing an education to become a medical biller or medical coder will open up a career field that can provide a great future for anyone, whether they are a new high school graduate, a mother returning to work or a person simply looking for a new direction for their working life to take. For those who have an interest in healthcare but enjoy administrative work it is a career option well worth exploring further!

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