Many of us, of a certain age, experienced our first encounter with the healthcare system during our mother’s prenatal visits. That means that the healthcare system has been a part of your life since before you were born. In fact, the first person touching you was probably a healthcare professional.

That said, the average person most likely has not considered this giant system that we call healthcare. However, healthcare is a mega system with systems within its structure that affect everyone to some degree. There is the clinical side to healthcare, as well as the administrative side. We’re all familiar with the trillion dollar pharmaceutical industry. Then there’s durable medical equipment and medical supplies. Natural healthcare, my preference, is finally becoming more mainstream. There are also specialties that deal with the human body from the top to bottom and the inside out. There are so many modalities and other details of clinical healthcare that administrative professionals are needed to manage paperwork, billing, coding and reimbursement. Of course there is much more involved in managing this complex system, such as the fraud and abuse side that requires the expertise to audit patient charts. However, since this is the truth about medical billing and coding, I’ll stay on topic.

Medical billing and coding is the process of correctly preparing and submitting healthcare invoices for payment of services rendered. This means that the medical notes for the dates and services billed must be coded accurately. In other words, the written words must be converted into acceptable codes in order to be considered for payment. There must be coding for the procedures, as well as the diagnoses. This process of converting words into alphanumeric codes requires knowledge of anatomy, physiology, medical terminology, and documentation protocol. Yes, of course there are books and online reference materials available to assist you.  Another requirement is experience in submitting billing forms to different types of insurance carriers. To some this may sound difficult, to others it sounds like an exciting and rewarding challenge.        

So, how do you get started? If you don’t already have a background in healthcare, the first thing to do is get acquainted with human anatomy and physiology. If you are able to manage it, study medical terminology and diseases at the same time. This will get you ready for your new career faster, however, going at your own pace based on your schedule will probably keep you more focused. If you prefer to learn on your own schedule, search for online courses. You can also order reference books online. If a classroom setting fits your personality and schedule more, check with community colleges in your area for training. 

After you have successfully completed the medical terminology, as well as the anatomy and physiology studies, it’s time to learn coding. Medical coding basically has five classification systems. However, the Current Procedural Terminology (CPT) codes and the International Classification of Diseases (ICD) are the two most commonly used classifications. So even though your career in this field could be in specialties that don’t use all the classifications, it’s good to be familiar with all coding. 

So, whether you’ve completed your medical billing and coding classes and/or training online or elsewhere, the next step is deciding how to use your new skills, credentials and knowledge to help healthcare providers “get paid for what they do”. There are so many opportunities for this high demand career. Do you prefer to use your skills as an employee; independent contractor; business owner; or consultant? Are you available part time or full time? Do you have a specialty preference? Are you more interested in coding and billing for outpatient or inpatient services? The truth is even though coding and billing can be learned by the average person, if you don’t already have a health background, it will take time to get acclimated to this system. Knowing this will help you to determine the feasibility of seeking to venture out on your own versus employment for experience and educational purposes. For example, employment will allow you to gain experience, as well as new skills. Working in an environment with other professionals will allow you to network for future connections. Your employer will also require and probably pay for you to attend workshops, conferences and seminars for continuing education. This will help you to save money for future endeavors. Remember, there’s more to medical billing and coding than most programs teach. You’ll need to be familiar with guidelines, protocol, rules and regulations, especially as it relates to Medicare. You’ll need to understand HIPAA regulations, as well as Managed Care Organizations guidelines. The information is readily available, however, you can save some time by supplementing your personal studies and research with the education offered by other organizations. The more you know, the more of an asset you are to your employer and/or clients. This knowledge that you glean from continuing education will give you an advantage over the competition. It will also allow you to offer more services if the business model is your goal. If you do decide to go the employment route, employment agencies can be a resource to help you get started. Of course, you probably won’t earn as much, however, it’s a start when you’re having difficulty securing employment on your own. Employers require prospective employees to pass tests related to the applied for position. Employers also require prospective employees to pass background checks due to the sensitive personal information that medical billers and coders access. I’ve been asked if working for an employer, as well as securing clients as an independent contractor at the same time is a good idea. It depends. You always want to give value and create a reputation that will lead to more referrals. So I suggest that you have everything in order before accepting clients. Even when you are providing services as a business or independent contractor, there will be an interview to determine if the prospective client is interested in contracting with you. So be prepared to answer the questions that will help the interviewer determine your level of expertise. Other things you will need are equipment, software, reference materials, online subscriptions, supplies and more to get started. You will also need legal contracts to keep everything professional and in order. Contracts have to be renewed at specific intervals, so having stable employment helps when contracts are not renewed.

I suggest that you create a to-do list regardless of your career scenario. That list should contain the steps you need to take to move you toward your goal. You need to write the vision that you have for this new venture clearly. For example, have you discovered that you gravitate toward a specific specialty or specialties? What does it look like for you and what do you need to do to get there? You could start by applying for employment within those parameters, as you learn as much as possible about your chosen field. It’s easier to learn a subject when you find it interesting. This would be a good time to research all the career paths available in the medical billing and coding realm. The truth is the financial rewards already exist, however at this point, it’s more important that you immerse yourself in becoming great at what you do, so that the money follows.  

My next suggestion is that you evaluate your skills and abilities in other areas. If you’re going to become a business owner, independent contractor, or even an employee, you’ll need marketing skills. You will definitely need time management skills. Your schedule will need to include time to remain updated and current on changes within the healthcare system. You’ll also need to be detail oriented. After you’ve evaluated your skills, consider other alternatives for the areas that you need to delegate. You might want to improve your skills in those areas if your budget doesn’t allow for these additional expenses. Searching online for reputable sites will provide you with many free resources to help you accomplish your goals.

Finally, there are so many scenarios as it relates to medical billing and coding. I’ve briefly offered you a few suggestions to consider based on your plans and goals. But, I think that you can be creative and design a working arrangement that is tailored to your personality and lifestyle. In other words, as you become proficient in assessing, reviewing, strategizing, implementing and following through in this profession, you’ll instinctively know what is needed to efficiently streamline the process involved in medical billing and coding. 

Now let’s briefly discuss how important it is for medical billers and coders to understand the medical claims process to reduce the number of rejected and/or unpaid charges. The medical claims process is a series of checklists that every claim must pass through before the insurance provider approves payment. This process varies according to healthcare payment plans. However, staying current with changes and updates will help to prevent the need for resubmitting claims.    

This means that you will need to make sure that you are receiving and reading all the correspondence that you receive from payors. Healthcare payors include patients, employers, government programs, commercial plans, and others. Codes are updated with changes and deletions annually, so having current physical coding references, as well as online coding references is a must. I think it is wise to have both because technology can sometimes disappoint.

Speaking of technology, healthcare has come a long way, especially as it relates to electronic health records. The Centers for Medicare and Medicaid Services defines Electronic Health Records as follows:

An Electronic Health Record (EHR) is an electronic version of a patient's medical history that is maintained by the provider over time, and may include all of the key administrative clinical data relevant to that person’s care under a particular provider, including demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data and radiology reports. The EHR automates access to information and has the potential to streamline the clinician's workflow.  The EHR also has the ability to support other care-related activities directly or indirectly through various interfaces, including evidence-based decision support, quality management, and outcomes reporting.

EHRs are the next step in the continued progress of healthcare that can strengthen the relationship between patients and clinicians.  The data, and the timeliness and availability of it, will enable providers to make better decisions and provide better care.  

For example, the EHR can improve patient care by:

Reducing the incidence of medical error by improving the accuracy and clarity of medical records.

Making the health information available, reducing duplication of tests, reducing delays in treatment, and keeping patients well informed to make better decisions.

Reducing medical error by improving the accuracy and clarity of medical records.

So the truth about medical billing and coding is that entering this field requires an investment of time and money initially, and there are no shortcuts to success. So, be mindful of promises made by individuals or companies that guarantee high earnings immediately, regardless of credentials and/or experience. The truth is, just like anything, you’re going to have to really want to succeed to succeed. When you get discouraged, remember that there are many medical billers and coders who are doing what you desire to do. If they can do it, so can you!   

Possible Interview Questions:

Tell me about yourself.

Why are you interested in this position? 

Tell me about your healthcare experience.

How long have you been a medical biller?

How long have you been a medical coder?

Describe your work ethic.

How have you been an asset to your current or past employers?

What are your future plans?

How flexible is your schedule?

How do you handle challenges?

Nina Bazemore: ancientlyprogressive@gmail.com

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