By Steven Andrews
Finishing the requirements for a certificate or associate degree in medical coding and billing is only the beginning. Now’s the time to begin applying for positions and testing your skills. Your job search likely won’t be long because the demand for medical coders and billers is high. The Bureau of Labor Statistics reports that employment in the health informatics field will grow faster-than-average by 15 percent through 2024. Healthcare providers can’t be reimbursed and remain profitable without medical coding and billing specialists. Here’s what this in-demand job will entail after graduation.
Medical coders and billers oversee crucial steps in the reimbursement process to keep the revenue cycle flowing. Medical coding specialists will carefully review patient files in the electronic health record system. By following the doctor’s notes, they’re able to assign numerical codes to the diagnosis and treatment provided. Coders flip through resource books to determine the right CPT or ICD-10 codes for each patient service. Every cost, including lab tests, consults, medications, and treatments, gets coded. Medical coding specialists often talk with physicians or nurses to clarify any unclear patient information.
For medical billing jobs, the daily duties will differ. Medical billers collect the records that have been coded to turn treatments into invoices. They assign financial values to patient services and submit insurance claims to the proper carrier. Billing specialists interact with the insurance company’s representatives to get claims processed. If coverage isn’t available, medical billers will send out bills to patients and follow up until they’re paid. When claims are denied, they also spearhead the appeals process on behalf of patients. Some medical billing specialists assume basic accounting roles by drafting accounts receivable reports.
Typical Work Environment
Medical coders and billers work behind the scenes in office cubicles for healthcare organizations. Most of their day is spent sitting at a desk, typing on the computer, and speaking on the phone. The desks of medical coding and billing specialists are often stacked with reference materials, claims forms, and patient files. They work independently because paying attention to detail is essential for accuracy. Direct patient contact isn’t common unless they must answer invoice questions from an uninsured individual. Medical coding and billing jobs are usually full-time with normal 40-hour weeks from nine to five, but part-time scheduling is offered too.
Virtually all healthcare organizations depend on a medical coding and billing team. The majority, around 38 percent, are employed in state and private hospital systems. Medical coders and billers also work in physician offices, outpatient centers, clinics, specialty hospitals, rehabilitation facilities, and managed care organizations. Others work on the opposite side of the claims process for health insurance companies. Experienced coders could work for government agencies like the Department of Health and Human Services (HHS). Although it’s important to beware scams, some medical billing and coding jobs are remote for working from home.
Since medical codes and insurance laws continually change, schooling never really stops in this profession. Becoming certified is the best way to advance your career. The American Academy of Professional Coders offers the industry’s certifications. The Certified Professional Coder (CPC) credential is available to those with two years of coding experience and 36 continuing education units. There’s also the Certified Professional Biller (CPB) and Certified Risk Adjustment Coder (CRC) designations. Experience can lead to advancement in other avenues too. Coders can eventually become medical records technicians, coding managers, clinical data analysts, and health information directors.
Building a career in medical coding and billing provides many benefits without a long trek into higher education. Graduates of online or on-campus training programs will utilize state-of-the-art software technology to coordinate patient payments. The career path offers an average yearly salary of $ 40,430, or $ 19.44 per hour, with room for advancement. Medical coding and billing jobs place workers at the helm of keeping healthcare systems profitable and cost-effective.
Did you know that the HHS inspector general’s office has a “most wanted health care fugitives” list? It is publicly listed on the OIG website where they are seeking more than 170 fugitives on charges related to health care fraud and abuse. This month, a fugitive that has been on the run for over 20 years was finally caught and arrested.
Robert Allen Lopez, who pleaded guilty to Medicare fraud on December 14, 1995, was arrested April 2016, at Miami International Airport. He is in custody and will face additional federal charges. Lopez fled the country after pleading guilty but before his sentencing hearing.
According to the indictment, from July 1991 until June 1994, Lopez and others conspired to defraud Medicare by filing false claims and structuring cash transactions to evade federal currency-reporting requirements. The fake claims totaled more than $ 4 million. OIG investigators found that Lopez established numerous companies in Miami, using sham owners to conceal that he was the true owner. These companies filed false Medicare claims on behalf of beneficiaries for services that were either medically unnecessary or were not provided.
Lopez also recruited friends and relatives to assist him as sham owners, according to the indictment. He directed them to open bank accounts where the fraudulently obtained Medicare reimbursements were deposited. To avoid reporting requirements for cash transactions exceeding $ 10,000, it is believed that Lopez directed the sham owners to make structured cash withdrawals from the accounts. When Lopez violated his bail agreement and left the country, he fled with his two children without his wife’s consent. His 10-year-old son was found four years later wandering the streets of Cancun, Mexico. The child was taken into protective custody and reunited with his mother in the United States.
Lopez was captured after OIG agents, together with the State Department Diplomatic Security Service (DDSS), got a tip that he was living under a false name in Nicaragua.
Agents from DDSS and the U.S. Marshals Service worked with the Nicaraguan government to apprehend Lopez and arrange his return to the United States