A career in medical billing and coding is an attractive option for individuals who want some assurance that their job isn’t likely to disappear in the foreseeable future. Many office jobs, including secretarial and office administrator positions, are less plentiful than they were in years past. The ability of professionals to use technology to prepare documents and to store data on a hard drive without the assistance of typists, clerks, and secretaries has made it more difficult for support workers to find traditional office employment.
Medical billers and coders, on the other hand, are working in a growing field. The demand for healthcare services will continue to increase as the national population continues to age. According to the Bureau of Labor, jobs for medical support personnel, including medical billers and coders, will increase by 9% to 11% over the next ten years. Jobs for general office clerks are expected to decline by 2% in the same period.
Medical Billing and Coding Employment
The demand for medical billers and coders cannot be met by workers who have general clerking or secretarial skills. The job requires specialized knowledge that can only be acquired through education, training, and experience.
Medical billers and coders must be familiar with medical terminology. Medical billers and coders typically gain or refresh their knowledge of medical terminology by taking classes.
The most specialized aspect of medical billing and coding involves a mastery of Current Procedural Terminology (CPT) codes. The American Medical Association had developed more than 10,000 CPT codes to identify services and procedures that doctors provide to their patients. The codes describe different kinds of office visits and examinations, surgical procedures, the administration of anesthesia, lab tests, and other services for which healthcare providers bill.
Medical bills include CPT codes so that insurance companies can make the correct payment for services rendered by a healthcare provider. Insurance companies, the federal agency that pays for Medicare, and state agencies that pay for Medicaid and other medical benefits all require that medical bills identify services and procedures by CPT codes.
Medical billers and coders take specialized classes to help them understand the complex principles that underlie the selection of a correct CPT code. Choosing the correct code is essential to assure that patients are not billed too much or too little for a procedure. Mistakes generally cause insurance companies to reject billings and will delay a provider’s payment until the billing is revised. Coding errors may also cause billings to be challenged in court.
Medical billers and coders base their choice of the correct CPT code on information they find in medical records. Their classroom education prepares them to understand those records and to prepare medical bills that reflect accurate CPT codes. They also learn about a separate code that reflects the patient’s medical diagnosis. Medical coders and billers become proficient in specialized computer software that they will use to prepare medical billings.
Employers and Work Environments
Medical billers and coders are primarily employed in the healthcare industry. They work for hospitals, clinics, urgent care centers, nursing homes, and doctors’ offices. Hospitals alone employ about a third of medical billers and coders, while nearly 20% work for doctors’ offices.
Most healthcare facilities establish a billing department that is separate from the medical records office and nursing stations, but medical billers and coders often interact with other staff if they need assistance understanding specific entries in medical records. Medical billers and coders do not typically interact with patients, although a manager might meet with patients to answer questions about their bills.
Insurance companies also employ medical billers and coders. Insurance companies review bills carefully to determine whether procedures are covered and whether the billing accurately reflects the procedures that were rendered. That review is conducted by medical billers and coders at the request of claims managers. Some companies outsource that review to businesses that offer medical billing review services to the insurance industry. Those businesses are another source of employment for medical billers and coders.
Like insurance companies, government agencies rely on medical billers and coders to review billings to assure that the agency is not being billed in error. Medicare, Medicaid, billings for covered services provided to members of the military and veterans, the State Children’s Health Insurance Program, and Indian Health Services are among the government agencies that employ medical billers and coders. In addition, medical billers and coders are employed to help government agencies compile nationwide or statewide data about medical services.
Medical billing experts help lawyers understand whether medical billings are accurate and whether they reflect the usual, customary, and reasonable charges for services in the community where the services were rendered. Lawyers need that information when they seek or contest reimbursement of medical bills in personal injury and related cases. Medical billing experts also help lawyers prove claims of fraud that are brought by whistleblowers within a doctor’s office. Those cases typically involve deliberate overbilling in claims submitted to Medicare for payment.
Medical billing experts who work for the legal industry are sometimes employed in-house by law firms. It is much more common, however, for lawyers to hire an outside firm of medical billing experts to provide analysis and expert testimony.
Working from Home
The pandemic gave employers an opportunity to experiment with having employees work from home. Many employers found that worker productivity improved when employees did not need to be in the office every day. Since medical records are increasingly maintained in an electronic format, medical billers and coders are often able to access all the material online that they need to work from home.
More traditional employers like to keep employees in the office so they can be supervised. Some employers think that medical billers and coders are more productive when they can speak in person to staff members who can answer questions about medical records. And some doctors and clinics still keep records on paper, which makes them difficult to access from home.
Whether a medical biller or coder can work from home, therefore, depends on the employer. The profession does, however, create opportunities for people with a medical billing and coding background to work as freelancers or independent contractors. Once a medical biller and coder has gained experience and made contacts, it is often possible to work from home by being self-employed.