Medical Billing and Coding Job Description, Training and Salary

If you've been thinking about taking some medical coding or medical billing classes online or getting medical coding or billing training you want to make sure you understand what this career and the job entails and have a good idea what kind of salary you'll make. Of course you may want to open a work from home business and it's certainly possible but may require a good education and training and an entrepreneurial ability to do so.

Going into a home business is not for everybody and getting on the job experience first is a good idea unless you have extensive education and feel like you completely understand the billing business.

Medical billing means you would be documenting patients' visits to a doctor, clinic or hospital or other type of health facility. Medical billers, assistants or Specialists enter clinic and patient information into expensive billing or practice management software so you can submit medical claims to health insurance companies. You would also be posting payments from insurance carriers and patients and run off management reports. You may also be required to make follow up calls.

Medical billing doesn't have to be done in a doctor's office. You can do billing from home, any office, clinic or hospital, billing service or facility that has the necessary software. Many doctors outsource their billing and may choose a home based business if the service is competitive in terms of cost. Or they may choose a smaller service and not necessarily one of the large billing services. So cost is a factor.

Medical coding is a totally separate function and not a part of the medical billing business. Medical coding cannot be done from home or outsourced to a service. Medical coders usually work right in the doctor's or clinic's office doing the coding before it is sent on to the billing service. Coder's salaries are comparable to medical biller's salaries.

So if you decide to get medical billing training you don't have to worry about coding and vice versa. People usually choose one or the other. Medical billing is more popular and offers more versatility since you can work from home in either your own business or for a doctor or clinic that allows you to do that.

Billing services often have graveyard shifts and may run around the clock. Salaries to start out run at least $10 an hour and up depending on your training, education and or experience, or related experience. You can move up fast as you gain the experience on the job and can command a much higher salary for the experience you're getting both from the clinic, practice or company you're working for when and if you leave for another medical billing job.

You don't need national certification, for example, as a billing specialist but it may help you get your foot in the door faster. There is money available for both your local on-campus and online medical billing training too. Make sure to check out online schools thoroughly to avoid any scams.

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CPT 99213 - Learning the Basics of E & M Coding Guidelines

CPT 99213 is defined as: Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components:

• An expanded problem focused history; • An expanded problem focused examination; • Medical decision making of low complexity usually, or straight forward as the presenting problem(s) are of low to moderate severity.

A physician will be left with the options of billing E/M for either code 99211 thru 99215 for an established patient. Usually, the correct level of CPT code (ignoring coding by time) can often be narrowed down to two or three choices by a proper evaluation of the patient and documenting the office visit correctly. The usual choices that remain for the physician at the end are 99212, 99213, 99214.

There might be times when the physician wants to put a code down without really understanding the complexities of the coding system and that will end up leaving money on the table which we are trying to avoid.

For example:

If an established patient presents for a second follow-up of a single complaint such as chronic cough and it is decided that it is stable or improving, a CPT 99212 may be warranted.

However, in the evaluation of the patient, if the provider takes an expanded history and the physical exam is re-evaluated to include performance and documentation of at least six bulleted elements from one or more organ systems or body areas. Then it will qualify as an expanded problem focused exam. That being said, if your History and Physical Exam meet criteria, then the Medical Decision Making is not needed in the calculation of the level and you may capture your 99213.

Remember, in an established patient, you need only meet two out of three criteria; History, Physical Exam and Medical Decision Making to qualify.

That being said, we certainly will be making a medical decision, but according to the 1997 guidelines (which I prefer to use for a variety of reasons) we capture our 99213 as long as the medical necessity is apparent.

In another example, If the same patient has a single straightforward new complaint to discuss with the examiner, during the follow up for the chronic cough, such as an orthopedic complaint that is worsening, a CPT 99213 and even a CPT 99214 depending upon the complete exam fulfilling two out of the three main components (that being History Physical Exam and Medical Decision Making (MDM) may be appropriate. Of course, medical necessity is required to substantiate the level of service billed.

As a physician, if you consider billing by time then a 99213 requires an average of visit of 15 minutes in which at least 7.5 minutes or 50% of your time was spent in counseling or coordinating care.

Remember, CPT 99213 requires documentation of at least one system when you compare it with CPT code 99212 and an expanded problem focused (EPF) history is required as well for a 99213.

The revenue captured from properly documenting a 99213 over a 99212 can add up to thousands of dollars annually. You want to make sure you are properly documenting your medical records and capturing the revenue you deserve based on the work you are performing. You do the work, get paid for what you do.

Employee and Employer Concerns   How to Choose the Best Medical Billing Service   CMS Announces "Meaningful Use" Rules   Important Difference in UK Vs US Health Insurance Models