It is easy to become qualified for a career in medical billing and coding. It's not always easy to find work for both, however. Both industries are reluctant to hire people without experience, though it's easier to get a job as a medical biller than as a medical coder. If you're looking to start a business doing each of these, there are issues there as well. For both, the training and learning curve is harder and the information more voluminous than most people realize.
Medical Coding
When people talk about medical coding, most of the time they're talking about diagnosis coding. Coders have to read every note within a medical record, then make a determination as to what the major diagnosis is, and all contributory diagnoses as well. Physicians will give an indication of what they believe, but it's the medical coder who has the official say.
In a hospital or clinic, there's a medical records department that usually handles that. For a small physician's group, coding is often handled by the physician. For a large physician's group, they might hire someone to code their bills. Diagnosis coding takes longer to learn than billing and special certification.
Medical Coding Issues
Heavy penalties are charged for incorrect coding. As an example, "upcoding" is on the fraud list of the Office of Inspector General. This occurs when a patient diagnosis is coded higher than the actual diagnosis would be.
Diagnoses impact inpatient payments, and upcoding indicates that a patient received a higher level of care than required. For example, there's a major difference in reimbursement to a hospital if something is coded as a urinary tract infection instead of septicemia, though both may seem similar to a coder. If there are a higher percentage of septicemia diagnoses than what the OIG has determined is normal, they will do an investigation. If they find upcoding issues, they will claim fraud, and fines can reach into the millions of dollars.
Coders also need to know code everything in a person's chart that may be relevant to the reason they are seeking care. They also need to figure out which diagnosis is primary. Sometimes it's cut and dried, other times it isn't. For example, if a person seeks treatment for a toe infection, additional coding may be required if that infection was caused by another condition.
Medical Billing
There are two types of general medical billing: physician's billing and facilities billing. Facilities may encompass hospitals, clinics, nursing home, etc. Physician billing is separated by the fact that it's billed on what's known as a HCFA-1500 form almost exclusively. Facilities will often use both the HCFA-1500 and the UB-04 for billing, depending on who, for whom, and what they're billing.
Medical Billing Issues
There are hundreds of reasons medical bills aren't , and it's up to the medical billing professional to figure it out. Reasons can include:
• Incorrect charges on a claim
• Incorrect codes on a claim
• Incorrect personal or demographic information on a claim
• Incorrect identification numbers on a claim
• Coordination of benefits issues (determining which insurance is primary if a patient is covered under more than one policy)
• No authorization number
• Missing charges
• Incorrect units of service
Costs of Starting Either Business
The costs for starting both of these businesses are relatively low, though much lower for medical coding. A medical coder can start a business with an ICD-9 book and nothing else, although purchasing coding software would reduce the time it took to arrange codes properly. Medical billing will cost a little bit more. The person would have to purchase both medical billing software and paper forms. Because of the paper, file cabinets would be needed. Also, billing records must be kept for years; each state has their own regulations.
Tags: claim Incorrect, medical coder, also need, Medical Billing, medical billing, medical coding