What Is Medical Billing and Coding?
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What Do Medical Coders Do?
According to the Bureau of Labor Statistics (BLS), medical coders "assign the diagnosis and procedure codes for patient care, population health statistics, and billing purposes." Generally speaking, this means they review the patient information created each time a patient seeks health care services. From there, they ensure the proper coding of patient data so that all services are billed properly through health insurance claims.
Government sources also point out that medical coders can function as a liaison between providers and billing offices in the health care industry, such as Medicare and Medicaid. As a "middle man" of sorts, medical coders use information on services rendered from health care providers and turn it into information that medical billers can use to bill individuals and insurance companies.
The coding process is fairly straightforward. The core tasks of medical coders include the following:
Reviewing and analyzing health records for the purpose of turning the data into codes using CPT, ICD-10-CM and HCPS Level II classification systems
Checking with health care providers to ensure assigned codes are correct
Most medical coders work in hospitals, although other popular work environments include physicians offices and government agencies. Medical coders may work full-time or part-time, and work schedules can vary widely based on the setting of the health care facility and specifics of the role.
What Do Medical Billers Do?
Once medical coders take information from health care providers and assign the proper codes for billing, medical billers take over from there. These professionals take the codes and information prepared by the medical coder and use them to submit claims to insurance companies or create bills that patients need to pay. If an insurance company pays part of a claim submitted to them, the medical biller will send out another bill to the patient for the remaining balance.
Medical billers also follow-up with all parties to make sure their employer is compensated properly, whether they work for a hospital or medical office. Most of the time, these professionals use medical billing software to perform their job duties in a timely and accurate fashion.
The fundamental tasks of medical billers include the following:
Submitting claims to insurance companies and patients
Following up with bills to ensure payment
Checking all bills and payments for accuracy
Helping patients set up payment plans for amounts owed
Facilitating collections activity on past due accounts
Like medical coders, billing specialists typically work in hospitals, doctor's offices, and a variety of other health care settings. These workers also perform their job duties on a full- or part-time schedule, depending on the needs of their employer.
What’s the Difference Between a Medical Biller and a Medical Coder?
While medical biller and coder job roles are intricately connected, the two types of professionals in this industry focus on different aspects of the work at hand. The biggest difference between medical billers and medical coders is the fact that coders use their in-depth knowledge of medical classifications to translate health reports into codes that billers can use. Medical billers pick up the process from there, taking over the billing process and tracking aspects of their organization's payment systems.
The biggest difference between medical billers and medical coders is the fact that coders use their in-depth knowledge of medical classifications to translate health reports into codes that billers can use.
Medical billers and coders may work in tandem to help their organization get paid for their work, but it's important to note the following key differences:
- The day-to-day tasks of medical billers and medical coders are different.
- Medical billers typically spend more time providing customer service to patients and insurance companies.
- Medical coders may only deal with health care staff and typically have less personal interactions in general.
- Certifications for this industry can vary, with medical billers and medical coders pursuing different credentials depending on their roles.
How To Become a Medical Biller or Coder
Medical billers and coders typically need a postsecondary certificate to enter their profession, although associate degrees are also common. Although a bachelor's degree is not a prerequisite, it's important to note that employers typically require certification, and professionals can pursue multiple designations in this industry.
Interestingly, many training programs teach students how to do both of these jobs at once. Most of these programs take approximately one year to complete.
For those interested in entering this in-demand industry, follow these three steps:
Step 1
Choose a medical billing and medical coding certificate program or degree program. You can get started in this career with any number of medical billing and coding certificate programs, many of which can be completed online from the comfort of your home. These programs offer a certificate in the end, but it's also possible to earn an associate degree in this field.
Step 2
Decide which career path you want. As you learn the ins and outs of medical billing and coding during your training, decide which aspect of the industry you're most interested in. For example, would you rather work behind the scenes assigning complex medical codes? Or, would you rather work with patients and insurance companies to facilitate accurate and on-time payments for your organization?
Step 3
Take an exam and become certified. There are several different certifications in this field, which we'll explain in more detail below. While the certification you choose to pursue should depend on the medical coding or billing career you're after, consider some of the most common designations: the Certified Professional Coder certification, the Certified Billing and Coding Specialist certification, the Certified Coding Specialist certification, and the Certified Coding Associate certification.
Medical Billing and Coding Careers
While most of the jobs in medical billing and coding are related somehow, one can hold a variety of job titles in this industry:
Medical Billers and Billing Analysts
Medical billers and billing analysts in this industry work in the accounting departments of hospitals, medical offices, and insurance companies. They generate bills, issue invoices, and ensure their employer is ultimately paid for medical services rendered. They may also initiate collections activity on past-due invoices, or help their organization's customers set up payment plans.
Coding Specialists
Coding specialists, or medical coders, use their considerable knowledge of medical codes and systems to assign codes for the purpose of medical billing. They typically work with health care professionals to ensure coding is accurate and fair based on the services a patient received.
Medical Records Technicians
Medical records technicians work in a role that is somewhat adjacent to medical billers and medical coders. These professionals retrieve medical records of patients so they can check them for accuracy. They also organize medical records and ensure their safe storage so they can be quickly retrieved each time updates need to be added to a patient's records.
How Much Do Medical Billers and Coders Make?
According to recent data from the American Academy of Professional Coders (AAPC), medical billers and coders without certifications earn approximately $47,200 per year. However, those with certification earn an average of 27% more — approximately $60,097 per year. Rather than relying on the BLS for this section, we use 2022 salary data from AAPC because they provide the most current figures and greater detail about this career's outcomes.
The AAPC notes that medical coders with multiple credentials can earn even higher salaries. In fact, professional coders with two credentials earn an average salary of $64,712, while those with three or more credentials earn $69,942 per year.
How much you can earn as a medical biller or coder also varies widely based on where you live. Data from the AAPC shows that the following states pay medical billers and coders the most:
Data from the AAPC shows that the following states pay medical billers and coders the least:
See our Medical Billing & Coding Career Guide for more details about job possibilities, annual salaries, and outcomes in this field.
Medical Billing and Coding Certifications
There are several medical billing and coding certifications you can pursue, with the right one depending on the specific role you hope to transition to. Professional certifications in this field are offered through the AAPC, the American Health Information Management Association (AHIMA), and the National Healthcareer Association (NHA). Each designation has its own set of initial requirements or suggested education before the applicant can sit for a certification exam.
Certified Coding Associate (CCA)
Offered through AHIMA, this certification helps professionals demonstrate competency in the medical coding profession. Candidates who pursue this certification must have a high school diploma or equivalent and be able to prove six months of coding experience, completion of an AHIMA-approved coding program (PCAP Program), or completion of "other coding training program to include anatomy & physiology, medical terminology, basic ICD diagnostic/procedural and basic CPT coding."
Certified Coding Specialist (CCS)
Also offered through AHIMA, the CCS credential proves a practitioner's coding proficiency and accuracy. Candidates who pursue this certification do not have to meet any specific requirements to sit for the exam. However, AHIMA suggests (1) having at least two years of coding experience; (2) taking courses in subjects such as anatomy & physiology, pharmacology, medical terminology, or reimbursement methodology; (3) or holding another related credential, like the CCA
Certified Coding Specialist – Physician-based (CCS-P)
This AHIMA certification program is geared to medical coders who want to work in physician's offices instead of a hospital setting. There are no set requirements for professionals who want to sit for this exam. However, the AHIMA recommends at least having the CCA credential plus one of the following: (1) at least one year of coding experience, (2) related courses in the medical field, (3) or at least two years of practical coding experience in a hospital or physician's office.
Certified Professional Coder (CPC)
This certification is offered through the AAPC and is geared toward medical coders who want to prove proficiency in the field of physician-based medical coding. While there are no minimum requirements to sit for the CPC exam, interested applicants can improve their chances of passing by enrolling in a CPC preparation course through the AAPC. Both the preparation courses and CPC exam can be completed online.
Certified Professional Biller (CPB)
This certification from the AAPC is for medical billers who want to show their mastery of all skills required to maintain revenue for their employer. There are no official requirements to sit for this exam, although having experience in medical billing can help applicants prepare.
Certified Billing and Coding Specialist (CBCS)
The CBCS certification is offered through the NHA. Eligibility to take the exam for this certification requires a high school diploma (or equivalent) and the completion of a medical billing and coding training or education program within the last five years. However, applicants can also become eligible by completing one year of supervised work experience in the medical billing and coding field within the last three years.
Frequently Asked Questions About Medical Billing and Coding
What Will I Learn in a Medical Billing and Coding Program?
Degree and certificate programs in medical billing and coding help students learn how CPT, ICD-10-CM, and HCPS Level II classification systems and codes work and how to assign them within a health care setting. Students also learn about the financial and billing aspects of various health care organizations, including how to create and send invoices, the basics of accounting, and more.
How Long Does It Take To Complete a Medical Billing and Coding Program?
Most medical billing and coding programs lead to a certificate, although associate degrees are also common in this field. Generally speaking, it takes one year to earn a certificate in this field and up to three years to earn an associate degree.
How Much Does Medical Billing and Coding School Cost?
While the cost of attending a medical billing and coding school can vary, our internal data shows students pay approximately $1,000 to $5,000 to pursue a certificate at the best online medical billing and coding schools.
As an example, Albany State University's online Certificate in Medical Coding is at the low end of the scale, with a tuition of $1,140. This certificate requires 27 credits and prepares students to take the CCA national credentialing exam from AHIMA.
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