What is Medical Coding & Insurance Billing?

A Medical Coding & Insurance Billing program at the California Healing Arts College (CHAC) prepares individuals to effectively and efficiently maintain a patient’s medical record and other health and medical information. Medical Coding & Insurance Billing is an important behind-the-scenes part of our health care system. Certified Medical Coders & Billers communicate between medical offices, patients & insurance companies. By assigning letters & numbers to diseases & conditions, injuries & medical procedures, they speed up the process of payment.

Medical coding and insurance billing professionals require an ability to focus on details, and should have patience. Problem-solving skills are also useful and essential, as coders are required to determine which part of each medical report is relevant to bill / code for. Medical coders should have knowledge in the following areas:

• Blue Cross and Blue Shield Plans
• Completing CMS-1500 and Commercial Claims
• CPT Coding
• ICD-9-CM Coding
• Insurance Claim and Regulatory Considerations
• Medicaid
• Medicare
• Tricare and Workers’ Compensation

Duties performed by a coding & billing specialist may include any combination of the following:

• Appropriately filling out and filing medical insurance forms
• Assigning a code to each diagnosis and procedure

AAPC Licenses

The American Academy of Professional Coders (AAPC) offers several types of medical billing and coding certifications:

• Certified Professional Coder (CPC): To become a CPC, an individual must pass a coding certification examination sponsored by the AAPC. The examination consists of questions regarding the correct application of CPT codes, ICD-9-CD diagnosis codes, and HCPCS procedure and supply codes used for billing professional medical services to insurance companies. To sit for the exam, an individual must have at least two years of coding experience and is required to maintain yearly renewal and CEU (continuing education) requirements.
• Certified Professional Coder – Hospital (CPC-H): To become a CPC-H, an individual must pass a coding certification examination sponsored by the AAPC. The examination consists of questions regarding the correct application of CPT codes, ICD-9-CM diagnoses, and procedure codes used for billing facility services to insurance companies. To sit for the exam, an individual must have at least two years of coding experience and is required to maintain yearly renewal and CEU requirements.
• Certified Professional Coder – Payer (CPC-P): To become a CPC-P, an individual must demonstrate that he or she has the skills and knowledge to arbitrate provider claims effectively. The CPC-P certification demonstrates the payer coder’s proficiency, aptitude and knowledge within the payer environment. To sit for the exam, an individual must have at least two years of coding experience and is required to maintain the appropriate amount of yearly CEU requirements.

AHIMA Certificates

The American Health Information Management Association (AHIMA) offers the following credentials:

• Certified Coding Associate (CCA): Even without much job experience, a new coder can earn the CCA immediately in order to demonstrate competency in the field.
• Certified Coding Specialist (CCS): Certified Coding Specialists are professionals skilled in classifying medial data from patient records, generally in the hospital setting. To become a CCS, an individual must possess expertise in the ICD-9-CM coding system, as well as the surgery section within the CPT coding system. Additionally, the CCS should be knowledgeable of disease processes, medical terminology, and pharmacology.

NHA Certificates

The National Healthcare Association (NHA) offers the following credential:

• Certified Billing & Coding Specialist (CBCS): To become aCBCS, an individual must pass a coding certification examination sponsored by the NHA. The examination consists of questions surrounding administrative procedures for medical billing and insurance claim processing, as well as submitting, tracing, transmitting, and appealing billing claims for a full range of health plans.

The U.S. Bureau of Labor Statistics states that medical billing and coding is one of the ten fastest growing allied health occupations. Employment for Medical Records and Health Information technicians is expected to increase by 21% between 2010 and 2020, according to Bureau of Labor Statistics.

Medical billing & coding training provides an opportunity for graduates to benefit from the expanding health care job market. As demand for medical procedures continues to grow, medical coding is increasingly crucial to a facility’s smooth and successful operation.

Once hired, medical coders and billers hold secure jobs, with good futures. Supervisors often spend weeks or months directly training medical billers and coders. Once they are properly trained and have gained experience by participating in the daily office routine, there is a strong possibility that their positions will be long term.

Graduates of CHAC ’s Medical Billing & Coding program can choose to work in a variety of locations, including (but not limited to):

• Group practices
• Hospitals
• Insurance companies
• Multispecialty clinics
• Nursing care facilities
• Pharmacies
• Physician offices
• Rehabilitation / Specialty centers
• Working from home

In California, Medical Billing & Coding Specialists earn a mean wage of $34,160 to $42,270, according to Bureau of Labor Statistics, U.S. Department of Labor, May 2012.

(a) Be a high school graduate or equivalent
(b) Be at least 18 years of age
(c) Be physically fit enough to perform the required tasks for your training