Online Class: Introduction to Medical Coding

The area of healthcare involving the completion of paperwork outlining patients' billing histories and submission of them to the individual's insurance company for reimbursement is known as 'medical billing'. Within medical billing there exists the practice of 'medical coding' whereby codes are assigned to medical procedures and diagnoses in order to relay--in a universally accepted medical language--information to the insurance company or in some cases, governmental agencies and/or consulting firms.

 

Also known as 'insurance coding', medical billing/coding is viewed to be essential to the healthcare industry for it creates and maintains a single, unified language by which all (physicians, medical administrators, insurance companies, government healthcare officials) integrated parties are able to effectively communicate.

 

In this course, we're going to learn medical coding from the ground up. Whether you are new to medical coding, or already have experience, this course is written in 'laymen's terms' yet is comprehensive enough to help even seasoned medical coders.

 

The healthcare industry, complex and rigorous even for the most knowledgeable and thorough of professionals, requires that paperwork be submitted both in a highly accurate and very timely manner.

The area of healthcare that involves the completion of paperwork outlining patients' billing histories and the submission of that paperwork to the patients' insurance companies for reimbursement is known as "medical billing."

Medical billers/coders help physicians' and hospital administrators' by reducing their workloads in matters pertaining to billing and reimbursements.

Essentially, the medical coder translates a physician's notes regarding a patient's medical condition and prescribed treatment(s) into the universally accepted language known as Current Procedural Terminology (CPT)discussed in greater detail within a subsequent chapter either manually or with the assistance of specialized software.

CPT codes exist for all medically-related interactions, i.e., office visits, x-rays, prescription medications, etc. International Classification of Diseases, Clinical Modification (ICD) is a second system in which alpha characters and numbers are used to identify specific diagnoses. A unique combination of both ICD and CPT relay to the third-party payer (insurance company, et al.) the patient's pronounced condition and the treatments received. (Please Note: ICD-10-CM is a separate class).

For payment purposes, there are two primary classes of medical services for which patients are billed: Procedures and Evaluation & Management (E/M) services.

Formerly, medical work operated on what was known as the Usual, Customary and Reasonable system (UCR) in which the costs of procedures and E/Ms were individually determined by the physician or facility in question. However, in light of the government's desire to grant everyone access to equal quality care, standardized methods became required practice.

Therefore, along with ensuring patients are receiving a bare minimum standard of care, they can also be guaranteed that they will not have to be pay excessive fees to receive it.

Additional reasons why the standardized coding system is so important include that the specialization helps deter fraud, and it contributes to the reduction of overall healthcare administrative costs and time overruns.

In light of the rising costs both inside and outside of the industry, there remains a pervasive, on-going need to reduce costs.

Because they are capable of keeping healthcare costs down and freeing up physicians so that they can focus on medical issues, the future demand for medical billers/coders in the United States, as well as internationally, is anticipated to dramatically increase over the course of the next few years.

Furthermore, additional medical billers/coders are needed because of the increased number of senior citizens (thus, greater need for healthcare-related services).*

*According to the U.S. Bureau of Labor Statistics.

Focused on the accurate and timely remission of reimbursement, medical billers/coders are expected to communicate well with physicians, patients, and insurance companies. In addition, they also should possess a working knowledge of medical terminology, comprehend the legal and ethical ramifications of the inaccurate labeling of treatments, and have a strong analytical aptitude for coding and decoding billable items.

In the past, candidates interested in becoming medical coders needed to complete either a two-year or a four-year college program. However, individuals can now acquire the necessary education in medical terminology and training through a technical or vocational school, online program, or correspondence course.

While medical coders do not officially need to be certified in order to perform the responsibilities of the job, many opt to do so as it increases their appeal to employers and their knowledge of the healthcare industry.

The AAPC also offers the Certified Procedural Coder-Hospital (CPC-H) certification, geared towards the institutional-type setting (hospital) as opposed to the private (physician) practice. The AAPC requires completion of a home training program and the completion of a certification exam given by proctors at a local chapter.

In addition, the AAPC offers a Certified Professional Coder-Payer (CPC-P) certification. This certification is for claims reviewers, utilization management staff, coordination of benefits staff, provider relations and contracting, and customer service staff. A CPC-P must have at least two years coding work experience that includes working with CPT, ICD-10-CM, or HCPCS code sets.

The AAPC requires that each certification maintain a required amount of yearly CEUs. Each examination requires a fee.  

Both the AHIMA and AAPC require that exam takers score a minimum of 70 percent or better on their exams in order to qualify for passing status and, thus, earn their respective certifications.

In addition, often times, as a follow-up to a passing grade on the CCS or CCS-P exam, the AHIMA may also conduct an in-person interview to ensure candidates are suitably well-versed in the areas of: medical terminology, coding protocols, patient charts, physiology, and medical/human anatomy.

The advantage to those with such credentials is that their qualifying organizations--the AHIMA or the AAPC--can help place them in medical coding positions with reputable organizations or medical office settings.

Regardless of which specific certification you decide to acquire (if, in fact, you decide to acquire any), the types of information you will need to be successful as a professional medical coder include:

• Medical coding
• Medical billers
• Medical auditors
• Medical claims reviewers
• Billing coordinators
• Reimbursement specialists
• Patient account representatives
• Medical claims analyst
• Medical claims processors
• Medical collectors

 

As anyone in the medical field can tell you, medical coding and billing might as well be considered a separate language. In order to decipher it, you’ll have to invest some pretty serious time and effort learning the secrets of medical coding.