This Medical Billing Program prepares individuals to become a specialist in their field. It helps individuals prepare for and know what to expect when on the job as a medical billing specialist. There is a high demand for medical billing specialists. Becoming a medical billing specialist is a rewarding career. A great benefit to working in the healthcare industry is gaining a sense of satisfaction helping others.
Saving lives may not come to mind when thinking about this type of career path but it’s completely possible to save lives when performing medical coding. Using the incorrect code can lead to dangerous situations. When a person codes correctly, they’re helping the patient with accurate treatment.
Gaining knowledge of anatomy and medical terminology is a key role for a medical billing specialist and it’s also an added benefit. Leaning about diseases, injuries, and other diagnosis is something that will come with experience and education during a medical billing program.
What is a Medical Billing Specialist?
A medical billing specialist works in a variety of places from physician offices to clinics, to hospitals. Some experienced medical billing specialists work remotely from the comfort of their home as contract workers. The location of where the job is doesn’t change the process. The specialist will handle the same work type in all locations. Duties of Specialist would include but are not limited to the following:
- Analyzing patient’s records to ensure accurate diagnosis and processing of the patient’s bill
- Concluding the correct code to use for the patient record
- Coding correctly for insurance providers to avoid denials and returns
- Collaborating with physicians and other medical personnel as necessary to ensure accurate coding
- Tracking patient’s data when there are multiple visits
- Managing very detailed coded information
- Maintaining patient security and confidentiality
Although most medical billing specialists work in a hospital setting, their work stations aren’t typically located close to patient care areas. Most of their work is independent aside from communicating with medical staff. This allows the medical billing specialist to help the patient from a far. This is a great benefit for those that want to help without having a hands-on experience with the actual patients.
A medical billing program trains individuals to code accurately. Medical coding requires an intense amount of attention to detail and patience. A medical billing specialist looks up the diagnoses and itemizes every service provided to the patient. If a service is missed in the billing process, the provider won’t get paid for that service. If the medical billing specialist uses the incorrect code, the provider may have to adjust payments or even face legal charges if any overbilling occurred.
Medical Billing Role and Support
In a medical billing program, training prepares the student for what to expect out in the field at doctor’s offices and hospitals. This includes working independently and with providers and insurance companies.
Being a medical billing specialist is a vital part of payment from insurance companies to providers. The medical billing specialist is the liaison between the providers, insurance companies, and the patients. A medical billing specialist will review patient charts to help determine what the correct diagnosis is and what services were administered. This information is then submitted through billing and sent onto insurance companies. The insurance company will determine what is or isn’t covered. If the insurance company denies a claim, reworking the claim is the next step. Understanding, interpreting, and reworking a denial is the responsibility of a medical billing specialist.
A medical billing specialist is not a physician, but they are required to think like one and understand cases and surgeries. At times it’s necessary to talk with the provider to retrieve extra information about the diagnosis of a patient. There will be times a diagnosis is vague and the need for extra details will arise in order to pin point the diagnosis that suites the patient. Even handwriting is an issue. Being a detective goes along with this type of work.
Medical Coding: ICD, CPT & HCPCS
There are three different types of medical coding that the medical billing specialist will use in day-to-day tasks. They include ICD-10, CPT and HCPCS.
ICD-10 Coding – The use of ICD-10 helps standardize medical coding internationally. The International Classification of Disease (ICD) helps record diagnoses by medical professionals including medical billing specialists. ICD consists of numeric and alphanumeric codes that follow an international standard, making sure that diagnoses are interpreted the same way by every medical professional that treats the patient around the world.
This medical billing program will include training in ICD-10. This is how diagnosis are established from the International Classification of Diseases. The clinical coding conventions for ICD-10-CM address the structure and format of the coding system. Clinical codes consist of three to seven characters. The first three characters identify the category of the clinical code, the next three characters identify the etiology, anatomic site and the severity, and the seventh character adds a specificity to the clinical code.
CPT Coding – Current Procedural Terminology (CPT) coding is a U.S. standard for coding medical procedures maintained by the American Medical Association (AMA). CPT identifies the services provided and helps determine how much medical offices is paid for their services through insurance company claims.
HCPCS – Healthcare Common Procedure Coding Systems is a set of health care procedure codes based on the AMA’s CPT system. HCPCS is a medical billing process used by the Centers for Medicare and Medicaid Services (CMS). The HCPCS coding system standardized the coding of specific items and services proved by health care professionals and billed to Medicare and Medicaid. The HIPPA Act of 1996 made the use of HCPCS coding mandatory for processing insurance claims through Medicare and Medicaid.
For ICD, CPT and HCPCS, there are computer coding software systems that aid with entering diagnosis and services. This saves time rather than thumbing through books. Although the software is faster, it’s important for a medical billing specialist to know how to look up information in the medical coding books. Every setting will experience down time where there isn’t access to a computer.
In the medical coding world, changes happen often. New information is sent out frequently and there is a constant need to learn how to code better. This means medical billing specialists are life-long students. It’s the responsibility of the medical billing specialist to stay up to date on new rules and changes in medical coding and laws. Large hospitals or networking offices usually help medical billing specialist by providing information, classes, and additional training.
Making the decision to become a part of the medical billing and coding world opens a door of exciting and unlimited opportunities. Growth and advancement are only limited by the effort that’s put forth by the medical billing specialist.
Did learning about medical billing programs interest you? Ready to attend Medical Insurance Billing & Coding program at Meridian College? Medical Billing and Coding professionals are responsible for keeping the records, charts and bills in a medical office in order. In addition to the classroom experiences, students will also complete an externship for on-the-job training that will bring them further expertise. Contact us to learn more about.
Contact Meridian College today to learn more about becoming a medical billing and coding professional.