Medical Billing and Coding

The American Academy of Professional Coders found in its 2011 National Salary Survey that 44% of certified medical coders in the medical billing profession earn between $35,000 and $50,000 per year. These figures are matched by the findings of the U.S. Bureau of Labor Statistics, which classifies medical biller and medical coders as Health Information Technicians.

With the dynamic changes in healthcare that are occurring every day, the demand for medical billers and medical coders is expected only to increase. In October 2013, a new diagnosis and procedure coding system will be put in place across the industry, providing thousands of new codes used to describe medical conditions and treatments. As the industry prepares for the implementation of ICD-10, well-trained professionals are earning the respect and salary they deserve.

Medical coding and medical billing training requires a thorough understanding of medical terminology, anatomy and physiology, and the art and science of medicine. This understanding is coupled with a background in the business of medicine. Medical coders and medical billers deal adhere to professional guidelines established by the U.S. Department of Health and Human Services, the American Medical Association, professional specialty organizations, the federal Centers for Medicare and Medicaid Services, and contractual obligations with private third party payers.

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Entry level positions often require formal training to ensure a baseline understanding of the complexities that make up the medical field. The Bureau of Labor Statistics found in September 2010 that a total of 176,090 people were employed in medical billing and coding. Of those, the majority were employed in inpatient hospitals. Inpatient medical coding follows different procedures than outpatient medical billing. Hospital coders often have a degree in Health Information Management, which encompasses medical record technology and maintenance, as well as medical coding and billing. Due to the complexity of inpatient billing administration, inpatient hospital coders usually earn above the mean income of coders in other situations.

The Bureau of Labor Statistics found that 41,450 medical billers were employed in physician offices. A physician medical practice can range from one doctor treating a small number of patients, to a large, cross-specialty practice made up of many doctors, nurse practitioners, assistants, therapists, technicians, and support staff. The billing office is where all the services provided by these practices are translated into industry-standard code, and the information is transmitted to insurance companies and government entities for reimbursement.

Because of the wide disparity between physician office sizes and resources, the average salary of $29,030 may seem low, but it accounts for small, general practices in rural areas, as well as large practices in metropolitan markets. Anecdotal evidence shows that the medical biller is considered one of the top tier professionals within the physician office setting.

Medical coders and medical billers are also employed in nursing care facilities, short-term rehabilitative hospitals, outpatient surgery centers, physical therapy clinics, nutrition clinics, and charitable, non-profit healthcare clinics. Wherever medical services are performed, those services are translated into code. Healthcare is a growing and dynamic industry that affects millions of lives every day.

The Centers for Medicare and Medicaid Services projects that in 2020, $46 billion will be spent on national healthcare. The vast majority of this money will be spent by third party payers, with the bills being submitted in code. The economics of healthcare delivery and accessibility relies on properly trained medical coders and medical billers who have a solid foundation on the precepts and principles of Common Procedural Terminology (CPT codes), the International Classification of Diseases (ICD-9 and, in October 2013, ICD-10), and the Healthcare Common Procedure Coding System (HCPCS).

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Knowing how these various coding methodologies are used to gain appropriate and justifiable reimbursement for medically necessary services is the specialty of medical coders and medical billers. The right education will provide the foundation of a successful career in a field that changes on a regular basis. With ongoing government mandates beyond those publicized in the media, the employment opportunities for skilled medical billers and coders can only increase. In January 2012, the entire industry converted its format for electronically submitted healthcare claims. While most news media did not cover the 5010 conversion, medical billers and coders made the transition smoothly due to their training and adaptability.

As the healthcare industry changes, trained, professional medical billers and medical coders will meet the challenges, keeping the healthcare industry running and providing necessary services to those who need it.