Rising healthcare costs, an aging population, an overburdened medical system strained by increases in chronic conditions and demand for services, and more, have all contributed to the need for specialized and more streamlined reimbursement guidelines and procedures aimed at ensuring appropriate delivery of service. They’re also prompting the development of new career and educational opportunities in the healthcare field.
It’s where Michael Harris has found a lucrative opportunity. With a career that spans 12 years, including positions in New York’s North Shore Long Island Jewish Health System and Bellevue Hospital, Harris is a standard-bearer in an area that sees few men and even fewer African Americans. Presently, Harris is the coding supervisor at Preferred Health Partners in New York. In addition to overseeing a staff of coders and billers, he educates physicians about proper documentation of procedures and services to make sure they’re in compliance with government regulations. This also helps to avoid audits.
Understanding the earning potential in the field, Harris leapt when opportunities presented themselves, taking a free coding course and earning the highest score. “Through networking and events you can meet a lot of people within the industry and build relationships with physicians to help you improve,” he says. “The field is wide open.” Since becoming certified, Harris has tripled his salary, does speaking engagements, and plans to eventually open a coding school and begin consulting on a national basis.
Medical billing and coding, the practice of submitting claims to health insurance companies and Medicare or Medicaid in order to receive payment for medical services provided by a health professional, is one of the fastest growing disciplines in healthcare, according to the Bureau of Labor Statistics. With specialized knowledge in high demand, certified professionals can secure work in almost any environment nationwide.
Billers and coders perform a wide range of functions including daily billing procedures, submitting insurance claims for reimbursement, documenting medical services performed using correct medical terminology, and adhering to insurance carrier’s policies and procedures. They work in a variety of settings including hospitals, physician’s offices, nursing homes, and law and accounting firms. Some billers and coders work independently from home while others with years of expertise can opt to work as consultants, troubleshooting and problem solving for a range of facilities.
Medical billers and coders are integral to the medical framework that supports and facilitates the healthcare landscape. Every service and procedure performed by a physician generates a code. No matter the ailment, treatment, or procedure, there is a corresponding code that describes it. The code is then submitted for payment to the patient’s insurance company, Medicaid, or Medicare. Medical billing is fundamental to a doctor’s practice and ensures that they are accountable—and paid—for the services they provide. Coders extract information from the documentation physicians provide in a patient’s chart and convert it to what is known as a CPT4 code, a five-digit number developed by the American Medical Association. The codes are then submitted for payment. Accuracy and a keen eye for detail are essential to the job. Coders also ensure that physicians are in compliance with current guidelines and regulations.
Why Medical Billing and Coding Is Important
With a career that encompasses knowledge of finance, accounting, and the business of medicine, it’s no small wonder that Stan Eason’s career trajectory has led to his current position running the financial operations of a hospital. As CFO of the Allentown, Pennsylvania-based Westfield Hospital, Eason is responsible for the facility’s financial planning, reporting, analysis and record keeping. He is part of the senior management team that establishes policies that ensure the hospital delivers quality healthcare while maintaining the bottom line—no small feat in these days of hospital closings, bankruptcies, and massive layoffs.
In an environment of rising healthcare costs Eason notes that commercial and government payors of healthcare services to hospitals and doctors, has declined considerably. Because of decreasing revenue, more physicians are joining hospital systems to contain overhead costs and expand their bottom line. This presents mutually beneficial opportunities for physicians and hospitals. But there are other business factors to consider. In an attempt to clamp down on fraud and abuse, inaccurate billing and overpayment of claims, the federal government has increased regulatory scrutiny. In 2005, the government created and implemented the Recovery Audit Contractor program to detect improper past payments on healthcare claims for services to Medicare beneficiaries. To date, RAC auditors have recouped more than $10 billion in improper Medicare payouts. With the increased need to be in compliance, physicians and healthcare facilities must ensure that payment submissions and the corresponding documentation accurately reflect the services provided.
The RAC reviews and other government regulations have affected hospital hiring practices and resulted in the need for more streamlined procedures, Eason says. “Now we must be concerned with issues like, Did the provider use proper coding conventions for reimbursement? Are mistakes intentional or out of ignorance? To be in compliance we need coders and billers who understand the ins and outs of coding conventions and regulations and who know how to apply them accurately and appropriately.” Now, says Eason, hospital hiring practices are geared toward these new concerns.
Education and Career Requirements
Entry into this career field requires completion of a medical billing and coding program at an accredited school. Classes include anatomy and physiology, medical terminology, and medical documentation evaluation. Tuition cost and program duration vary by school. Programs are offered through continuing education programs at local colleges or through accredited vocational or professional training schools. The average starting salary for medical coders is $30,000. Individuals with long career experience or a specialty can earn $75,000 or more depending on geographical location and facility size. Certification is required in most institutions.
Numerous organizations offer certification. Two major certifying bodies are the American Health Information Management Association and the American Academy of Professional Coders. AHIMA offers the designations of Certified Coding Specialist (CCS), and Certified Coding Specialist – Physician-based (CCS-P). Among the designations the AAPC offers is Certified Professional Coder (CPC), Certified Professional Coder – Payer (CPC-P) and Certified Professional Coder – Hospital (CPC-H).
Professionals must maintain their certification by accruing continuing education credits annually and keeping up with compliance rules and regulations.
Trends and Opportunities
Experienced billers and coders can work independently from home through electronic billing technology. Other options include insurance specialist or consultant, hiring or working with independent contractors that troubleshoot and provide revenue-driven guidance to major healthcare facilities. Billers and coders can also work as auditors, a lucrative option given that they receive a percentage of any monies recovered. One of the most significant areas of specialization: cancer registrars.
Registrars review patient records and pathology reports as well as assign codes for diagnosis, treatment, and procedures.
The field of medical billing and coding provides enviable earning potential, job stability, and lucrative job opportunities, and will play a vital role in rejuvenating the nation’s economy.