Medical coding and billing? (Career transition)

Lankysean

Can someone explain what exactly medical billing and coding is? I currently work as a salesmen selling phones for a wireless company. I do ok in terms a salary but it's a frustrating job and I've really grown to hate dealing with the general public. Before I got this job I used to do date entry which I assume is similar in nature to Medical Billing/coding. I used to actually enjoy my data entry job because it afforded me a lot of time to listen to audio books and such, plus it was a low pressure job which was always nice. So anyways, I'm thinking about getting out of sales and into medical billing and coding, and I was wondering if anyone here had any advice as far as training/certification needed, and which I might be able to obtain those things in New Jersey.

Thanks!

Fantasma

As far as I know this task is normally done by a clerk, secretary, Accounts Receivable assistan and such, there is a lot of paperwork and, communication exchange and phone calls involved.

This could give you some information:

http://en.wikipedia.org/wiki/Medical_billing_(United_States)

lordrel

It does take a bit of specialized knowledge. You need some medical knowledge to translate from doctorspeak. Then you need to know how the codes work together, and the rules each insurance company uses. Additionally, I wonder about the long term viability of the positions with the mass transition to electronic records. When I first started at this office, the doctors would circle codes on a sheet. We then had three people that would input these codes into our billing software, make adjustments as necessary, and print the claims. These three people also handled reconciling payments from insurance and patients, as well as appealing claims. Now, the electronic medical record software we use essentially does the coding for us. These codes are already scrubbed by the software, then transferred to our clearing house for transmittal to insurance for payment. We have a little massaging to do to translate the claims due to software incompatibilities, but it's nothing like in the past. Of the three people I had working on billing, it's down to two...and only one of those really works on it full time. It's less about the data entry now, and more ensuring the coding is how each company wants it.

Deebaser

Basically, medical coding translates everything a doctor is legally allowed to do to you into a 5 digit number called a CPT (Current Procedure Terminology?) code. This is then put on a HCFA1500 (for doctor billing) or a UB92(for hospital billing). This allows the insruance company to know how much to pay a doctor with a fee or service contract.

You really don't need a degree in it per se, I know a few people that worked in small professional offices without a degree in that specifically, but I imagine larger or more niche specialties may require either that or experience.

Source: 5+ soul crushing years in health insurance.

Thanatos

Deebaser wrote:

Basically, medical coding translates everything a doctor is legally allowed to do to you into a 5 digit number called a CPT (Current Procedure Terminology?) code. This is then put on a HCFA1500 (for doctor billing) or a UB92(for hospital billing). This allows the insruance company to know how much to pay a doctor with a fee or service contract.

You really don't need a degree in it per se, I know a few people that worked in small professional offices without a degree in that specifically, but I imagine larger or more niche specialties may require either that or experience.

Source: 5+ soul crushing years in health insurance.

What Deebaser said. I will say that your major competition in this industry is going to be the wives of doctors. And if they can figure out how to do it well enough to maintain a revenue stream (I really wonder how a lot of them manage to put on pants in the morning), you should be able to handle it. Keep in mind that a ton of it is going to be being on the phone with support for your billing software company, being on the phone with Medicare, being on the phone with Medicaid, being on the phone with Tricare, being on the phone with Blue Cross/Blue Shield, and if you have the misfortune of being in a small state or near a state border, being on the phone with multiple different states' versions of those insurances (save Tricare, which is the same throughout the country).

bowen

Also keep in mind, dealing with customers is roughly equivalent to dealing with insurances companies, and about as frustrating.

Edit: god damn forum making people necropost?? Rage @ myself for not noticing it.