60% of the total health care workforce in the United States of America contributes towards allied health care services. Patient care and support services are as critical as medicine and nursing for holistic and efficient functioning of the health care system.
Data Source: https://en.wikipedia.org/wiki/Allied_health_professions
It is estimated that between 2010 and 2020, the growth of the health care industry will have a favorable impact on allied health care professionals as the number of jobs are expected to shoot up to 19.8 million from 15.6 million.
Owing to increasing insurance claims, health care awareness, and aging population, the focus on health care is growing manifold, thereby increasing the demand and employment opportunities for health care professionals.
Allied health care professions require many skills depending on the specialization and these skills can be acquired through well-defined training courses offered by recognized and accredited institutions. Getting certified in the field of specialization is an added advantage as it attracts employment opportunities from credible employers.
Of the several allied health care professions, the exigency for medical billing and coding specialists is expected to grow much faster than all other occupations through 2024. Due to evolving rules and policies of the health insurance companies, and upgrades in the medical management software, it is preferable to have specialized training for medical billing and coding professionals.
Medical Billing and Coding: A Universal Language
Though both are closely related, medical billing and coding are two separate fields in the health care management system. However, most employers prefer hiring candidates with specialized skills in both. An entry-level qualification for medical billing and coding can be achieved through the completion of a diploma or certification, or an associate degree, in some cases
Severe scrutiny of medical records and claims has made medical billing and coding an administrative support specialty requiring specialists to deliver the job. The data produced by these specialists becomes an integral part of the health information system. The recorded data can be used by governments, private health care organizations, and agencies for various causes including health care management and review, research, education, stipulation of laws and policies, developing case studies, etc.
The medical billing specialist is responsible for realizing the payment cycle, which commences upon the inception of an appointment and is completed once the health care service provider receives the full payment.
Fig: Overview of Medical Billing and Coding Process
Details of the patient’s treatment including the tests and diagnosis report, treatments and procedures performed, medicines prescribed, equipments used are translated into universally accepted codes by a medical coding specialist. These codes are essential in creating the ‘claim’ for the services provided to the patient.
Why are Codes Used?
Patient visits generate prodigious amount of information or data that needs to be recorded and shared with concerned authorities for processing payments and dispensing other health-related services. Coding provides for the uniform documentation of patient records.
Medical coding enables easy interpretation of medical reports and claims by all involved health care entities including insurance companies. The World Health Organization maintains the most widely recognized and used medical classification of codes called the International Classification of Disease (ICD). ICD lists codes for diseases, injuries, and symptoms. ICD codes are employed to describe the patient’s condition and the causes in the claim prepared by the medical billing and coding specialist.
The American Medical Association (AMA) publishes and maintains the widely accepted medical nomenclature, the Current Procedure Terminology (CPT). Medical procedures performed to treat patients are translated using CPT codes and entered into the claim.
Codes for medical supplies and support services such as ambulance, medical devices and equipments, prosthetics, etc are listed under the health care Common Procedure Coding System (HCPCS). HCPCS codes are crucial for government-endorsed insurance plans like Medicare, Medicaid and other insurance programs. The implementation of the Health Insurance Portability and Accountability Act has mandated the use of HCPCS codes.
Medical billing specialists function as the financial gateways between the patients, the medical service providers, and the insurance companies or the payers. The billing specialist, through creation of the claim, provides payments to the medical service provider(s) for the services they render to the patients.
Medical service providers, in this case, could be doctors, hospitals, private clinics, emergency rooms, therapists, outpatient facilities, and any other health care professional or entity that serves or treats patients.
All the information about the treatment and medical services provided to the patient is collected by the billing specialist and used to create a claim. Additionally, the claim covers the cost of the services and the patient’s medical history and insurance coverage details.
Upon verification of all the facts stated in the claim, the billing specialist directs the claim to the insurance service provider. The payer reviews the claim to approve the payment for the service provider. Upon receiving the payment, the billing specialist calculates the remaining amount and sends it to the patient in order to receive the complete payment for the service provided.
Medical Billing and Coding Training and Certification
Medical billing and coding specialist programs in Connecticut and other states of America prepare aspiring candidates for careers in this field.
Certificates provide proof of knowledge validation and certified specialists carry higher employment potential. Certification for this profession can be availed from the following credible organizations:
1. Certified Professional Coder (CPC) examination and certification from American Academy of Professional Coders (AAPC)
2. Certified Billing and Coding Specialist (CBCS) exam and certification from the National health career Association (NHA)
3. Certified Coding Associate (CCA) credential from the American Health Information Management Association (AHIMA)
Individuals aspiring for a career in the health care industry which can be achieved within a short span of time without spending exorbitantly on tuition fee can choose from among the many allied health care professions. The U.S. Bureau of Labor has projected high growth for this industry, with the average growth for medical billing and coding specialists being the highest. Qualified and certified professionals can expect parallel growth along with the industry, and look forward improved job security. Above all, if one is inclined towards caring for and serving others, the health care industry will certainly offer profound job satisfaction.