By: Karen Mooney, MBA, BS, CPC, CPC-I, CMSCS, CHI
There is a large misconception from those that are just entering into the medical administration field. Many people believe that billers and coders are one in the same. In reality, there is a big difference on the focus between these two categories. A medical biller is focused on data entry of claims, claims processing, claims follow up, accounts receivable, patient billing, and collections. Billers also make very strong registration specialists and front desk staff. A medical biller is a strong strength when it comes to collecting funds due by the patient at the time of appointments as they know what to look for. Billers are also great enforcers of referrals and authorizations that may be necessary for payment of services. One other avenue that could work for a biller would be working in the health information department as billers are trained on HIPAA requirements and the need for completed medical records.
When a person is considering a coding profession, there is much more challenge in this aspect due to the level of knowledge that is necessary to perform the duties of a coder. A coder must understand the working knowledge of the ICD-9-CM as well as the CPT coding reference. Coders are responsible for making sure that when coding services and procedures that the diagnosis that has been provided supports the medical necessity for the service before these are forwarded for processing. Medical Coders hold a very large responsibility in their hands when performing their daily duties and are completely responsible for what they code. Coders can find work in physician offices, clinics, hospitals with the right background of training. From there, coders become quality reviewers, advanced educators, auditors, and consultants.
When individuals are researching new careers, the medical profession is a great choice as there is a long line of stability in the medical profession. With that said, locating the best focused training is very important to a person’s success. History has proven that the most direct route into medical administration is through the billing side of the profession. This provides a great passageway into the field and allows many opportunities to a new comer to the medical field. Practices and physicians are more likely to hire individuals that are right out of school for a billing position versus a coding position. The reason for this is that the coders hold a large responsibility of a physician’s revenue in their day to day process. Physicians are completely aware of this fact and are less apt to hire a person, right out of school without any live experience in the coding realm.
When researching your career path, and you are looking to learn to become a Medical Biller, then you want to focus on a program that will be sure to provide you with the background knowledge of the types of insurances, patient’s responsibilities, what can and cannot be processed from a billing side of the process and still covering an introduction of ICD-9 and CPT coding. An introduction to ICD-9 and CPT does not make a biller qualified to work as a coder. If you are looking to become a coder, be sure that the program offers you an entire review of the CPT coding reference. This process should be a minimum of 3 months to accomplish the course you are looking at. If you decide that a medical biller and coder is the program that you are interested in, the program should be a minimum of 9 months to ensure that you have learned the skills necessary for both specialties. The most direct process is to become a biller and introduce yourself to the profession in the billing community, build experience, continue to code, then work your way into a coding position within the profession. Ultimately the final decision is yours. You need to make the best decision for reaching your final goal. Just remember that anything worthwhile is worth working towards.