The Increasing Demand for Billing & Coding Workers

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The Increasing Demand for Billing & Coding Workers

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Billing & Coding Workers In High Demand

With the looming prospect of sin-gle-payer health insurance in the U.S. on the horizon, more and more clinics and private practices will need qualified individuals to process billing statements correctly so that claims are paid in a timely manner. As most medical offices move into the 21st century and shift away from paper-based claims submission to get paid faster, they are looking for staff trained to input data correctly, without denials or a lengthy resubmission process. This is where the need for front office medical staff is so critical and growing. Billing and coding classes can get you into the job market with all the skills necessary to satisfy this burgeon-ing industry.

At the core of billing and coding classes is the impor-tance of ICD-9 and CPT codes and how they relate to re-imbursement and claims payment. When a patient shows up at the doctor’s office or medical facility, there should be a valid medical reason, and this translates into a diag-nosis or ICD-9 code. There are literally thousands of these codes, and they are standardized by the World Health Or-ganization (WHO) so they can be used globally. While most medical facilities in the U.S. still use ICD-9 codes, other countries are using the revised ICD-10 codes, with

the changeover to the new coding system in the U.S. ex-pected to take place in October 2014. This will require-billing and coding classes for existing employees to learn the more detailed, in-depth coding system. Now more than ever, billing and coding classes are important to keep up with this changing coding landscape.

Because there are significantly more diagnosis codes in the updated version, billing and coding classes are required to bring medical billers up to speed to understand the anatomical and physiological requirements to get qualify-ing diagnoses. Previously, ICD-9 codes used five charac-

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Rapidly Evolving ICD-9 to ICD-10 Coding Path

The Increasing Demand for Billing & Coding Workers

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ters, with either all numerals or an alpha V or E, denoting health status and external causes, respectively. The ICD-10 codes have seven character spaces, which include any alpha character in the first position except for U, and X placeholders, if necessary, for the last three positions. Just as the Y2K conversion of medical databases required up-dated software to ensure that patient birth dates had eight characters instead of six, all billing software will need to be converted over, which has been the primary reason for the delay in the U.S.

So why is this conversion necessary? Medi-care and many insurance companies need to know pa-tient compliance in terms of treatment, and this will be even more important for single-payer accountability. For now, medical providers are required by Medicare to of-fer a breakdown of patient demographics and diagnoses; with the information provided by ICD-10 codes, you can show who’s following treatment plans, who’s not and what’s working, rather than pulling patient charting in-formation and looking it up case-by-case.

Another reason why billing and coding classes are necessary is the increased scrutiny of medical of-fices by insurers when it comes to billing practices and contracted reimbursement rates. This is where CPT (cur-rent procedural terminology) codes come into play, which denote the surgical, equipment or diagnostic service pro-vided. Connecting the correct and valid CPT code to a qualifying diagnosis ensures that charges will be reim-bursable, instead of denied and unpaid.

Poor documentation and incorrect coding in-variably lead to denials and delays in payment, which are the bane of any medical practice. For example, if you were trying to qualify a patient for a lightweight wheelchair, you would need an exact combination of documentation, certification, and coding to show justi-fication for that patient’s need of the lightweight wheel-chair. If each document, certification, and code is prop-erly submitted to the insurance company, the wheelchair gets approved; however, a missing piece of information or incorrect code may result in denial. Billing and cod-ing classes teach students which diagnoses will get claims paid to avoid a lengthy appeals process and possible claim denials.

As the cost of medical insurance, coverage re-strictions and capitation allowances rise, insur-ers are scrutinizing medical documentation to ensure that patients are receiving the appropriate level of care, and this is another instance where billing and coding classes are highly desirable. For instance, Medicare will pay for the rental then purchase of a CPAP (continuous positive airway pres-sure) machine for a patient who has sleep apnea. Again, the correct code (780.53) and proper documentation (of a qualify-ing sleep study and a face-to-face follow-up study) are required for the correct cov-erage. Billing and coding classes ensure that students are up to speed on revised guidelines and other roadblocks to getting bills paid.

Billing and coding classes also ensure that stu-dents have a thorough understanding of what constitutes protected patient health informa-tion (PHI) and the proper handling of such data. Since the advent of 1996’s Health Insurance Portability and Ac-countability Act (HIPAA), medical facilities have put se-

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The Increasing Demand for Billing & Coding Workers

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curity protections in place to ensure that patient informa-tion is treated with kid gloves. Since all U.S.-based medical and insurance information is typically linked with a social security number, protecting these documents, in an age of increased identity theft, is even more crucial, and the conversion of most medical offices to a paper-less system requires that front office staff be well-versed in security procedures, such as shredding documents when appropri-ate, locking out the desk top and limiting access to PHI on a need-to-know basis.

Most medical offices use proprietary software to track patient information, and in large urban areas these facilities may be connected to a health system. Al-though this is the most streamlined approach to medical information, in terms of accessing lab results, prescrip-tions, chart notes and insurance information, as well as scheduling patients, unless users are familiar with the software and are following HIPAA guidelines in terms of access, all kinds of problems could result. For example, a family member may call into the office asking about the billing for a patient. Unless this individual is noted in the patient file as a responsible party, the information cannot be released, and civil penalties and possible licensing is-sues could result. Any hospital or large medical provider seeks approval and accreditation by the Joint Commission (Joint Com-mission on Accreditation of Healthcare Organizations) if they’re billing Medicare. Billing and coding classes help ensure that these guidelines are met. Recent graduates of billing and coding classes know how to deal with patients, family members, insurance companies and other medi-cal offices when it comes to disseminating information, which makes them desirable at the point of hire.

The medical industry is one of the few set to grow through the mid-21st century and requires

a trained workforce to make sure claims are processed and paid in a timely manner. Consider billing and coding classes as a way to present yourself in a job interview as the best qualified and most capable applicant for the posi-tion, and you’ll be well on your way to a rewarding and successful career in the medical field.

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