+ What exactly is medical coding?

Every service (test, office visit, injection, surgical procedure, etc.) in the provision of medical care has a numeric code associated with it (ICD and CPT codes) designed to provide some commonality of terms in order that the companies who pay the claims (health insurance companies, HMOs, etc.) can identify the patient's problem, and the service provided sufficient to allow them to pay on a predetermined basis under the care and coverage limits of an insurance plan. The codes are also used for statistical data. The CPT (Current Procedural Terminology) codes exist for an office call, an injection, an x-ray, right on to the most detailed brain surgery. International Disease Codes (ICD) are the number systems assigned for diagnoses, even patient complaints (headache, upset stomach, etc.). The combination of using these codes, ICD and CPT, tell the payer what was wrong with the patient and what service was performed.

+ What kind of training does coding require?

The first requirement to learn to be a medical coder is medical terminology training (or a good background in medicine, such as nursing). Formerly, it took two to four year college programs to learn medical coding, however, currently training is available through Web sources such as Meditech. Practice is important and that's why the Meditech Coding Training Course has over 600 patient records for you to code.

+ Does coding require certification?

Providers who employ coders prefer some assurance of the coder's background and capability. Meditech provides the certificate on the training end and lots of graduates find work with that certification. Formal, but not regulatorily standardized, certification is available from several sources, AHIMA, AAPC, and our own Certification. If you'd like more on that, please contact us.

+ How much money can I make?

According to the industry standards, starting salary is about $35,000-$40,000 per year, higher in some areas of the country. A student graduate who set herself up in business charges $17 per outpatient report to code, and the average per report time involvement is two to ten minutes. Another Meditech graduate coder works at home, dials the hospital system, codes the charts and charges 70 cents per code. Two of our former students set up a claims auditing business in Montana for a self-insured employer, contracting for 50% of any funds recovered on claims already processed and paid. The first year, their income was over $100,000. Coders often become the "gatekeepers" for the preauthorization process for employers and insurance companies. This occupation is often filled by nurses who take the coding training.

+ What kinds of employers, or companies, require coders?

Virtually every provider, individual doctor, clinic, hospital involved in patient care requires coders. The American Association for Medical Transcription (AAMT) strongly encourages MTs to learn to code. Several of the larger MT companies also offer coding to their clients. The profession has enormous potential. One hospital alone may have as many as 50 or more coders on staff. Don't forget standalone clnics, urgent and semiurgent care and surgical, mental health centers and nursing homes. In addition, insurance companies, contract care providers, governmental agencies, law firms, third party administrators, billing and practice management companies, need coders. And the shortage of coders continues. As ICD10 codes emerge, the need for coders will increase substantially.

+ Is there a ready market for the skills acquired in coding?

There sure is, as you have probably surmised by now. Health care in America is an explosive industry accounting for the top 3 producers in gross national product (and income), and still outpaces all but a few industrial sectors in growth. Four million jobs will open up in the next ten years in the health care industry, and many, many of those positions are outside the care-giving arena specifically, such as consulting firms and claims-review/auditing firms. Coding is sufficiently specialized that coders are paid exceptionally well, are and will remain in very high demand.

Statistically, Health Information Management (HIM), of which coding is a part, is a rapidly growing field and is expected to outpace average job growth rates in other fields through the year 2016. According to the Occupational Outlook Handbook produced by Bureau of Labor Statistics of the U.S. Department of Labor, health information technicians are projected to be one of the 20 fastest growing occupations. The Health Insurance Specialist Training Course we offer is included in the Coding Course. More and more you will see help wanted advertisements looking for "Health Insurance Specialists." They are expected to know all about insurance companies, government plans, their requirements for preauthorization and submission of claims, the ability to calculate patient responsibility based on insurance payment criteria, all about HIPAA (privacy act management), and often have administrative roles. The Health Insurance Module is included in this training.

+ How far you go with this expertise?

Once you become proficient in coding many opportunities exist. Just as one example, Meditech charges a minimum of $200 per hour for code profile consulting for private practices and clinics. Consulting is an excellent business for coding experts, either independently, or for a consulting firm. Coders often undertake auditing functions. Independent fraud analysts are also in demand and often are paid a percentage of what they save insurance companies. One of the most common uses for fraud analysis is in state sponsored Worker's Compensation Funds, where fraud is rampant, accounting for a burgeoning percentage of America's health care costs. Many consultants and fraud analysts set up their own businesses and work at home. Consulting is a great field for nurses looking for a change in career.

Gatekeeping is another interesting job potential requiring terminology and coding. The gatekeeper is contacted when a policy holder needs a medical service for which the gatekeeper's intervention is required to determine the lowest possible costs without jeopardizing care, such as a surgery procedure, or a series of visits to a physical therapist. The gatekeeper refers to the policy's coverage and limits, refers to the appropriate code or codes, and determines what the payer (e.g., insurance company or employer) will pay for it, or determines whether the service is excluded. Depending on the health care plan, the gatekeeper then tells the patient which provider in the network is prepared to accept what the payer offers along with deductibles or copayments. If the patient decides to go outside this recommended network of care providers, then s/he will be responsible to cover any differential of the predetermined amount the payer is willing to pay. Gatekeepers commonly earn $60,000 to $100,000 a year. Many nurses fill these jobs.

Many employers are self-insured, which means that they establish a reserve account (like insurance companies) to pay for the medical care of their employees. "Third-Party Administrators" (TPAs) contract to manage the process. Gatekeepers perform the services to get the best economoic deal possible for patients and payers.

+ Can coding be done at home?

Formerly, it was a little cumbersome since one needed various forms and even patient charts; however, with the advent of all the new technology (computerized faxes, scanners, transfer of information back and forth through the Internet), it is now possible and acceptable to do the coding at home either as a contractor or an employee for a hospital or doctor's office. National companies fill a niche too and subcontract the work to home-based contractors. You will find a number of them using the Web. Read a forward looking article that agrees with our concept.

+ How do home coders get the patient information?

Records are obtained in various ways: picking up the forms/documents, faxing (encryption for privacy issues), and remote dial up access to provider computer data. Technology has improved the ability to move this information around quite readily.

+ What does medical coding have to do with transcription?

That's a simple one. Medical transcriptionists type the reports coders review to determine the treatment and diagnostic codes. Medical transcriptionists make excellent coders because of their knowledge of medicine, and, they have the document on their screen when completed. Many dictators now include the ICD or CPT code in their dictation.

+ What does medical coding have to do with billing?

When a care provider performs a service, s/he will dictate a report or check off a superbill noting the services provided. That textual document becomes a part of the primary record, and the coder reviews it in order to abstract and codify what was done. The codes are then printed on statements and insurance claims forms as an abbreviated way to define problem/s and service/s. Offering the combined service of coding and billing is an excellent approach to a private practice provider. Since coding drives the entire billing process, it is imperative that both skills are included in a career path planning process.

+ Is there anything else I should know?

Yes: Medical Terminology ;-D