What to Look For When Hiring Medical Billing and Coding Expert

April 17th, 2018 Expert Medical Biller

Sifting through the technical information contained within medical billing statements is something that certified billers and coders are specifically trained to do. There are a lot of professionals who seem to be getting into the business of providing medical coding expertise, including doctors and nurses. While these professionals certainly have knowledge of the healthcare industry, they are not necessarily the best choice to evaluate the technical complexities of medical billing and coding, that’s where you’re much better off looking for someone specifically certified.

There are two national organizations to keep an eye out for when considering hiring a medical coding expert. AAPC and AHIMA. Both organizations provide programs for individuals to become certified billers and coders. The AAPC, or American Academy of Professional Coders, is one of the largest credentialing organizations and provides the CPC, or Certified Professional Coder, and CPB, certified professional biller designations, among many others.

The CPC certification, validates proficiency in the correct application of CPT and ICD-10 codes. To obtain a CPC certification, a candidate must pass a 150-question exam covering questions regarding the correct usage of coding and billing guidelines and regulations. Passing this exam will allow the candidate to utilize the CPC-A designation, with the A signifying apprentice. It is not until the candidate has demonstrated a certain number of hours of coding work that they can have the apprentice designation removed and utilize just the CPC designation. Finally, once the candidate is CPC certified, they must submit 36 hours of continuing education units every two years to keep up with changes in coding and regulatory guidelines.

Certified Professional Billers have proven knowledge of how to submit claims in accordance with government regulations and private payer policies. To obtain this certification, the candidate must pass a 200-question exam covering questions regarding billing regulations, reimbursement and collections, as well as billing and coding. Once certified, CPB’s must also submit continuing education credits to maintain credentialing.

The second organization, AHIMA, American Health Information Management Association, provides the CCS, Certified Coding Specialist certification, among others. CCS’ are skilled in classifying medical data from patient records to assign CPT and ICD-10 codes accordingly.

Beyond these credentials, you want to ensure that the medical billing expert you intend to hire demonstrates experience in billing and coding settings applicable to the type of bills typically included in personal injury cases. This would include billing and coding experience in orthopedic, physical and/or occupational therapy, pain management as well as hospital settings. Having experience working in these areas gives the medical billing expert the tools they need to accurately evaluate a personal injury case.

Medical Billing Analysts (MBA) is a Nationwide Medical Billing Expert service with offices in NJ, NY, FL, TX, CT, GA, NV, and CA. To see how MBA can assist you in documenting the damages in your Personal Injury cases, consult www.medicalbillinganalysts.com or call 800-557-6141 for a proposal containing the experts’ professional qualifications, fee schedule, and sample Medical Expense Evaluation Report.