Advanced Medical Coding Solutions

Advanced medical coding is one of the most crucial steps in the medical billing process. It involves the translation of the medical and health information of the patient into corresponding codes. These medical codes are used within the healthcare industry to represent medical diagnoses, procedures/services, equipment, etc. Common universal medical alphanumeric codes include CPT, ICD-10, and HCPCS Level II. The entire medical coding process is the responsibility of the medical coder. 

What do Medical coders do?

Is medical coding a good career? Let’s find out!

As mentioned earlier, medical coding is one of the most crucial processes in medical billing. Medical coding takes place every time a patient visits a hospital. An entire record of the patient’s visit, diagnosis, imaging tests performed, services, treatment plan, and the outcome is kept. 

Medical coders review the patient’s file for billable information and translate it into specific or billable codes. Now using the correct and specific codes is critical for proper medical coding. The revenue and financial development of the healthcare practice are based on this. When discussing medical coding as a career, there are so many factors to be considered and too much information; for instance:

• Advanced medical coding certificate
• Employment opportunities in the industry
• Career paths in the healthcare industry
• Responsibilities 
• Skills required as a medical coder

But before diving into that, let’s first address the basic questions regarding advanced medical coding as a career. 

How much do medical coders earn?

According to a survey conducted by AAPC regarding the salary of medical coders, on average medical coders earn about $54,797 annually. This includes both certified and non-certified medical coders. 

However, on average, certified medical billers and coders can earn about $60,097 annually. Medical billers and coders without certification can earn approximately $47,200 per year, which is 27% less than certified medical billers and coders.

The salary of medical coders varies based on their experience, medical field, location of the employer, as well as credentials of the coder. Following is a list of some medical coding certifications along with their annual/median salary. Note that these are based on the survey conducted by AAPC:

Source: 2022 Medical Coding and Billing Salary Report, AAPC. 

Among the certifications mentioned in the list, CPC is one of the most popular among all. Although, there are many more certifications that aren’t mentioned in the list above. 

Education requirements for a Medical Coder:

Typically, medical coders are required to complete a training program. This can be done via a certification (e.g., CPC, COC, etc.). However, education may vary based on the type of medical coding. The specific academic requirements for a medical coding job depend highly on the organization/employer hiring.

Becoming a medical coder:

AAPC puts the process of becoming a medical coder (according to CPC certification) into five steps:

• Step 1: Complete Medical Coding Training
• Step 2: Pass the CPC Exam
• Step 3: Become and Maintain AAPC Membership
• Step 4: Verify Your Experience
• Step 5: Maintain Certification Through Continuing Education Units (CEUs)

Common Medical coding certifications:

Several medical coding certifications exist today; however, the following are some of the most common ones, 

• Certified Professional Coder (CPC)
• The Certified Coding Specialist (CCS)
• The Certified Medical Coder (CMC)
• Certified Outpatient Coder (COC)
• Certified Risk Adjustment Coder (CRC)

Skills required for Medical billing and coding:

Advanced medical billing and coding require a set of soft skills; they can help medical coders effectively handle any circumstances. Moreover, these particular skills play a significant role in successfully processing insurance claims. Following are some of the skills critical for a medical coder and biller:

• Communication skills:

Several medical billing-related tasks require interaction with people and good communication skills. These tasks could be:

• Getting pre-authorizations
• Interacting with healthcare practitioners for accurate patient information
• Follow-ups on the outstanding insurance claims from payers and patients

Medical coders may also need to answer questions like the explanation behind charges mentioned in the claim. Professional medical coders do work alone; however, from time to time, they have to interact with the team in order to understand the clinical documentation, etc. Being able to ask questions and discuss billing issues will ultimately help them in their medical coding career.

• Listening skills:

If the coder doesn’t understand what the physician is explaining regarding the patient’s condition, how will they use appropriate medical codes? Moreover, active listening skills are also essential as coders might have to interact with the insurance providers. 

• Problem-solving:

Issues in medical coding can lead to claim denials/rejections, therefore, late payments. When billing hits a snag, coders might need to work with the team, payers, and patients and figure out a way that suits everyone. Medical coding is more than translating the patient’s medical information into alphanumeric codes. 

For instance, claim denial requires proper research to find its reason/error and take the required action. 

• Attention to detail:

Even a minor change in word/digits/alphabets in a documentation/code can affect the selection of an appropriate code. Medical coders must have a vast knowledge and understanding of medical terminologies. Moreover, when selecting a code, medical coders have to be pretty precise and specific; one wrong digit can change the entire meaning of the code. Hence, the incorrect code.

• Time management:

Late submission leads to claims being denied or rejected by the insurance payer. Timely preparing the claim, their submissions, and meeting any other deadlines require time management and solid organizational skills. 

• Adaptivity:

The healthcare industry is forever changing with new technologies and advancements. Medical coders must be able to navigate through all of that, adapt, and learn alongside the evolving healthcare policies. 

• Computer proficiency:

The use of advanced electronic medical billing systems helps automate the entire billing and coding process. Medical coders must be proficient in computer use as they are required to learn and adapt to Electronic Health Records (EHRs). 

• Ethical:

According to HIPAA Privacy and security rules, safeguarding patients’ data is involved in a professional medical coder’s job. Moreover, as ethical conduct, medical coders will be required to report any fraudulent practices and unlawful activities in their practice. It also includes observing the insurance payer’s policies to avoid abuse or fraud. 

Where do medical coders work?

Several facilities and organizations provide career opportunities for medical coders besides hospitals. Some of the facilities are listed below:

• Physician practices
• Ambulatory surgery centers
• Urgent care clinics
• Sports medicine clinics 
• Mental health practices
• EHR software vendors
• Medical billing services
• Telehealth providers
• Consulting firms
• Clearinghouses
• Law firms and many more

Are medical coding certifications required?

For advanced medical coding services, proper certifications help individuals move ahead in their careers. Moreover, most employers expect to hire certified medical coders/billers. 

Medical coding certifications come with several benefits:

• Career advancements
• Increased job opportunities
• Increased salary

Other benefits of getting certified:

• Personal growth
• Professional connections
• Increased job flexibility
• Starting a career in medical coding in months instead of years
• Opportunity to be able to work from home
• Increased educational opportunities
• Advancement in the medical coding career

Medical Billing and Coding Services:

The healthcare industry is forever changing and evolving. And the healthcare providers effectively managing their medical billing and coding are the ones with a strategic advantage in the market. With this ever-changing environment, in-house teams must be up-to-date regarding all the changes/updates. However, managing medical billing along with providing quality patient care increases the workload. Errors in medical coding ultimately affect the revenues of the healthcare practice. 

Common Errors in medical coding:

Following are some of the most common medical coding errors:

• Use of an incorrect/outdated code
• Incomplete or inaccurate documentation
• Use of inappropriate modifiers; overuse of modifier 22
• Unbundling and upcoding
• Not being up-to-date with official coding guidelines and insurance payer’s requirements. 

Outsourcing Medical Billing and Coding services:

Advanced medical coding services and error-free medical coding is the reason why various healthcare practices outsource their billing process. 

Medical coding outsourced services offer high-quality, professional, and advanced medical billing for healthcare practices. Following are some of the benefits of outsourcing the billing services:

• Improved billing compliance
• Increased patient satisfaction
• Lesser risk of errors in medical billing and coding 
• Increased reimbursements and revenues
• More focus on quality and safe patient care
• Competitive and affordable pricing (cost-effective)
• Increased cashflows
• HIPAA Compliance
• Improved safety
• A team of highly professional medical billers and coder

   Advanced Medical Billing Solutions with U Control Billing:

With U Control Billing, gain complete control over your billing process. We understand that medical billing is a complex and tricky process, which is why we provide you with timely follow-ups and billing in 24 hours. Moreover, We ensure 100% privacy, discretion, and patient confidentiality in a secure environment.

We offer:

• Improved Quality & Increase in Revenue
• Billing in 24 Hours & Timely Follow ups
• Patient Support & Customer Services
• Competitive Pricing
• Reduce your overall expenses 
• Maximize your reimbursements 
• Uninterrupted service & stability

Our Services:

• Revenue Cycle Management (RCM)
• Medical Billing Services
• Front Office Management 
• Telemedicine Billing Services
• Medical Coding Services
• Medical Credentialing Services
• Medical Transcription Services

Medical Coding Services at U Control Billing:

Our medical coding services include:

• Improve your coding accuracy
• ICD 10 CM, CPT, HCPCS, NDC, and Modifiers
• Provider note Audits and Code Reviews
• Specialty and Payer specific coding requirements

Medical Billing Services at U Control Billing:

Our medical billing services include:

• Fee schedule review and analysis
• Eligibility verification.
• Referrals, Authorization alerts, Claim tracking, reduced rejections, and denials
• Patient statement processing, Mailing, Customized Monthly financial reports
• Rules-based claim review, scrubbing, and Insurance follow-up.
• Helping the collection agency to recover patient balances
• Always remain HIPAA Compliant

Frequently Asked Questions (FAQs)

• What is the highest level of medical coding certification?

COC certification (formerly known as the CPC-H) is a certification accredited by the American Academy of Professional Coders. This coding certification indicates a high level of competency in coding specific to

• Hospital groups
• Ambulatory surgical centers
• Hospital billing and coding departments

• Which coding is best in medical coding?

Certified Professional Coder (CPC) is an ideal coding certification for medical coders interested in working in an outpatient facility. It may be a clinic or a physician’s office. 

• What are the two types of medical coding?

Two of the most commonly used medical coding systems are CPT & ICD-10-CM coding systems. Current Procedural Terminology codes are the procedure codes, whereas ICD-10 codes are the diagnosis code. For instance, medical coding for advanced neurological degeneration; 2022 ICD-10-CM Diagnosis Code is G31.9 Degenerative disease of the nervous system, unspecified. 

• What are the three types of coding?

A medical coder uses three types of coding systems on a daily basis; these universal alphanumeric medical codes include

1. CPT
2. ICD-10-CM
3. HCPCS, Level II

Touseef Riaz

A couple of years ago, I executed the effective plan of creating a Medical billing and Coding company named U Control Billing. The company aims to bring revolutionary advancements to foster medical billing and coding revenues. As an official member of HIA-LI and MGMA, I feel honored in providing networking opportunities, problem-solving, and improving the revenue management cycle.