Medical Billing and Coding at the Center of Success

From the smallest medical office to the largest multi-state provider, in all cases operating a successful medical services establishment boils down to just a few key things, and one of these is finances. No business, healthcare or otherwise, can survive for long without a steady stream of revenue, and it is exactly this that medical billing and coding professionals provide.

Of course, there is a range of expertise and abilities among the nation’s more than 180,000 thousand billing and coding specialists. Competent professionals will be worth their own salary many times over to their employers. A skilled billing and coding professional will not only maximize revenue through accuracy and timeliness, he or she will also avoid costly liabilities that may be incurred through billing and coding mistakes. Last year a Boston-based medical billing agency and several healthcare providers it served were hit with a $140,000 fine because billing and coding employees had failed to shred documents with sensitive patient information.

Because they are so essential to the bottom line of healthcare providers, skilled medical billing and coding professionals will never become obsolete. Human medical billing and coding professionals are versatile and adaptable. As the adoption of the ICD-10 draws nearer – currently scheduled for October of 2015 – this will become all too apparent. Companies that use billing and coding programs will need to upgrade or buy new software, and it will be months before all the bugs have been worked out and employees have been trained to use the new system.

In contrast, the human machine will be able to adapt quickly to new coding systems, not to mention legislation. The best billing and coding professionals will have one foot in each world, bringing common coding sense along with knowledge of the latest advances in software. No matter the technology, the sensitive and complicated nature of dealing with materials like a patient’s health record will always require human oversight.

Medical Billing and Coding Credentials Available to Anyone in America

Each state can make its own regulations about required medical billing and coding professionals. However, the real regulation in this field lies with individual employers, who each set their own qualifications for hire. To start out, there are two basic classes of qualifications: academic and professional.

Academic qualifications are offered by institutions such as colleges, universities, community colleges, trade schools, and technical colleges. Relevant subjects of study for medical billing and coding professionals include any of the following:

  • Health Information Management
  • Medical Coding and Billing
  • Medical Office Management
  • Nursing Informatics
  • Medical Office Assisting
  • Health Care Administration
  • Healthcare Informatics
  • Medical Billing Specialist
  • Medical Record Administration

The resulting credentials from an academic program can be in the form of:

  • Diplomas
  • Certifications
  • Two-year degrees like an Associate’s of Science (AS), Associate’s of Applied Science (AAS), or an Associate’s of Arts (AA)
  • Four-year degrees like a Bachelor’s of Arts (BA) or Bachelor’s of Science (BS)
  • Post-baccalaureate Certification
  • 5 and 6-year degrees like a Master’s of Arts (MA) or Master’s of Science (MS)

Professional qualifications are offered by organizations and demonstrate that the holder of such a credential has completed a training program sponsored by the particular professional organization. These agencies may be recognized at the state, regional, or national level. Some of the most common professional organizations that offer medical billing and coding certifications are:

  • American Academy of Professional Coders (AAPC), offering:
    • Certified Professional Coder (CPC)
    • Certified Professional Coder – Outpatient Hospital (CPC-H)
    • Certified Inpatient Coder (CIC)
    • Certified Professional Coder – Payer (CPC-P)
    • Certified Professional Biller (CPB)
    • Additional specialty certification
  • American Health Information Management Association (AHIMA)
    • Registered Health Information Administrator (RHIA)
    • Registered Health Information Technician (RHIT)
    • Certified Coding Associate (CCA)
    • Certified Coding Specialist (CCS)
    • Certified Coding Specialist – Physician-based (CCS-P)
    • Additional specialty certifications