Crunching the Numbers Opportunities Are Abundant for Medical Billing and Coding Specialists

It’s called the ICD-9 CM. That’s short for International Classification of Diseases, 9th edition, Clinical Modification.

This is the bible, all 1,620 pages of it, for medical coding and billing specialists — and also for individuals who want to take that title. It uses the Healthcare Common Procedure Coding System (HCPS), which is a set of health care procedure codes based on the American Medical Association’s current procedural terminology, or CPT. “We help students navigate the book and learn how to use it,” said Tracey McKethan, chair of the Health Information Technologies in the School of Business and Information Technologies at Springfield Technical Community College.

She also teaches classes within in the Medical Coding and Billing Specialist (MCBS) program, which features both a two-year associate’s-degree offering and a one-year certificate option. Graduates of both programs, but especially the former, are finding themselves in demand these days, as the importance of coding and billing grows.

“We’ve come a long way from the days when these people were essentially doing data-entry work; they are now largely responsible for the financial well-being of their organization or employer,” said McKethan, noting that technology has changed health care, and this profession, considerably. And the changes keep coming. Indeed, electronic medical records (EMR, see related cover story) and the recently passed health care reform legislation are destined to place even more emphasis on the importance of accuracy when it comes to coding and billing.

In the meantime, ICD-10 CM, or the 10th edition, is coming out, and it takes the current five-digit billing system to seven digits, making the process even more complex. “It will look completely different,” said McKethan, adding that she and others will soon be attending seminars on the new book so that they can properly train the trainers in this increasingly technology-based realm.

“Years ago, this field used to be much more homegrown,” she continued, noting that the required skills were such that formal education wasn’t nearly as necessary as it is today.

“These days, there are more demands from the insurance companies, the IT demands keep growing; there has to be a skill set now … you can’t really learn this on the job.”

For this, the latest installment of its Career Focus series, The Healthcare News looks at the work done by medical coders and billers, and how it is becoming an attractive alternative for those seeking a second — or first — career.

Plotting a Course

McKethan said the Medical Coding and Billing Specialist program has become one of the larger health care-related offerings at STCC, with about 150 students (nearly 50 graduates each year), and for good reason.

There are a number of landing points for graduates, ranging from hospitals to insurance companies; from billing firms (to which work is outsourced) to physician offices. And demand for trained specialists is growing. Indeed, more than half of those who graduate each year have jobs waiting for them, said McKethan, and most others don’t have long waits to join payrolls, especially if they pass the certification exam.

McKethan said the program, the only one of its kind in Western Mass., is in a constant state of change or evolution as those who administer it try to anticipate and then meet the needs of the various types of employers that hire graduates.

There are some constants, however, she said, noting that students must be able to navigate the ICD-9, CPT, and thus have the skills to code diseases and procedures from patient records. And to do that, they must obviously understand medical terminology and anatomy/physiology and therefore be able to apply it to coding assignments.

They must have an understanding of the all-important relationship between coding and reimbursement, McKethan continued, and also know the insurance industry, its terminology, and requirements, and have a full grasp of the Health Insurance Portability and Accountability Act (HIPAA) and how it applies to coding and billing release of information.

And while all of that seems centered on knowing terms, policies, and numbers, graduates must also possess strong people skills, said McKethan, noting that, while coding and billing specialists work mostly behind the scenes, they must interact with people all day long.

“The soft skills play a big role is this field,” she explained, “especially with those working closely with patients and insurance companies.”

Responsibilities for coders and billers vary with the employer, said McKethan, noting that, in an inpatient setting, they are handling post-discharge work, such as processing, going through records, and coding the services provided to a patient so that the facility is question can be properly reimbursed. In an outpatient setting, such as a typical physician’s office, there may well be more actual involvement with the patient.

“They’re entering charges for the day, posting payments, posting payments from the insurance company,” she said. “They’re also billing patients, billing insurance companies, troubleshooting denials, working with patients to help resolve issues with claims … they’re managing a lot on the patient-account end.”

A look at the course lists for the MCBS program reveals the skill sets that graduates must possess to land in this field. In year one, in addition to taking general-education electives common to all programs at the college, students must take Basics of Anatomy and Physiology, Human Body in Health and Disease, Office Accounting One, Principles of Management, and both Health Office Basics and Health Office Advanced. In year two, the required classes include Advanced Coding, Electronic Health Record, and Facility/Hospital Billing and Reimbursement.

The curriculum is crafted to help students pass the certified coding assistant examination given by the American Health Information Management Assoc., which many employers now make a prerequisite for entry-level coding positions.

Those who do pass the exam and land jobs at those aforementioned landing spots often have opportunities to advance, said McKethan, especially at larger hospitals, medical centers, insurance companies, and billing companies that have managers overseeing departments of specialists. As for salaries, they vary with the employer and the responsibilities, but they are generally in the $16-to $18-per-hour-range in a large hospital, and perhaps $14 or $15 in a typical physician’s office, she continued, and can climb considerably higher as duties, and credentialing, escalate.

“There are many opportunities beyond coding and billing once people get established,” she told The Healthcare News. “There are positions like office manager, billing supervisor, and others that people can move on to. These are good positions with good salaries.”

These numbers and advancement opportunities are making the MCBS profession an attractive one for people looking for second careers, said McKethan, adding that such individuals comprise many of the spots in the current classes. Indeed, while students’ ages vary, current participants are generally in their 30s, 40s, or 50s.

By the Book

As she flipped through the ICD-9 CPT, McKethan stopped at the code number for diabetes — 250 — and showed how that three-digit entry becomes four for the various subclasses, such as opthomalic, and myriad other variables.

“This is where we get down to the nitty-gritty,” she said, with a phrase used to describe both the volume of diseases and conditions and the importance of the medical coding and billing specialist to his or her employer.

This job is all about attention to detail, she noted, and that explains why those who can navigate the book — and all the other challenges — are in demand.