When a medical biller also fills a coding compliance role in these situations, they often earn more than their medical billing counterparts in physician offices.
Healthcare facilities that see a smaller number of patients may combine the two roles of medical biller and medical coder in order to streamline operations and reduce operating expenses.
The coding certificate is currently approved by the AHIMA Foundation's Professional Certificate Approval Program (PCAP). The PCAP approval identifies coding education programs which have been evaluated by a peer review process against national minimum standards for entry-level coding professionals. This process allows academic institutions, healthcare organizations, and private companies to be acknowledged as providing an approved coding certificate program. In addition, program accreditation allows coding certificate graduates to apply for certification examination to become a Certified Coding Associate (CCA).
Medical billers use these codes to submit claims to describe medically necessary services that should be reimbursed at agreed-upon rates by third-party payers.
For this reason, both medical billers and medical coders need a solid understanding of how these codes are meant to be used, the kind of understanding that can only be gained through a formal education program of study.
Admission to the Coding Certificate program requires completion of an application. Applicants seeking admission into this program must successfully complete the background check, for more information please see the HIT department webpage. Students may be required to show proof of immunizations such as tetanus and MMR (mumps, measles, and rubella). Students may also be required to document negative results from a tuberculosis test. Applicants must cover the cost of the background check, immunizations and drug screen if required by clinical affiliates.
In some settings, a medical biller also serves as a medical coder and, in fact, medical billers are familiar with the basic precepts of accurate medical coding.
A certificate in coding prepares the technician to assign a code to a medical diagnosis or procedure. Medical coders consult classification manuals and rely on their knowledge of disease processes to assign codes. After completion of the certificate, students will be certified as a Certified Coding Associate (CCA) after successfully passing the exam administered by the American Health Information Management Association (AHIMA).
Both medical billers and medical coders review documentation in the patient’s chart to assign the most accurate code to describe the patient’s condition.
Medical billers are more knowledgeable about commercial insurance requirements, what codes can be billed, claim submission rules, and how to assemble a clean claim.
A professional medical coder is usually a member of a department separate from the billing department in the hospital setting, though medical coders communicate actively with medical billers who are assembling medical claims, in order to ensure that the information being transmitted is accurate and properly documented.
Medical billers spend their efforts making codes conform to specific payer requirements to describe medically necessary services for reimbursement purposes.
Smaller, rural hospitals, that may have as few as fifteen beds, often employ a small staff trained in both medical coding compliance and medical billing requirements.
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Every healthcare practice depends on a medical biller to ensure its financial operations in order to be able to continue providing medically necessary services.