Top 10 Reasons to Train for a Medical Billing and Coding Career

Medical billing and coding can be a demanding career. To succeed, you must be precise, you must be able to meet deadlines, and you must have enough medical knowledge to accurately identify a wide array of conditions, procedures and outcomes. Becoming a medical insurance biller and coder requires special training and you must regularly update your knowledge for as long as you practice your profession. Your performance can not only determine if a patient receives the proper course of treatment, but it can also expedite or delay payments that can total in the tens of thousands of dollars.

It’s a lot to think about.

But as demanding as medical billing and coding is, there are many compelling reasons to pursue it as your career. Here are 10 of them:

1. There’s a demand for trained professionals. Health care is one of America’s healthiest industries (no pun intended), accounting for 17.9 percent of our Gross Domestic Product (GDP)…and growing. As for medical billing and coding professionals in particular, the U.S. Department of Labor expects jobs openings to increase 21 percent between 2010 and 2020, a rate it describes as “faster than average.”

2. The field is secure. With America’s population aging, the demand for medical services and support personnel is only going to increase. Even if the U.S. went to a Canadian-style single-payer health care system, there would still be a need for specialists to handle the biggest thing the private and public sectors have in common: paperwork.

3. You can train quickly. Yes, you need specialized training, but if you have a high school diploma or its equivalent, you can usually earn your medical billing and coding diploma in one year or less.

4. It’s a health care position with no patient contact. An a medical billing and coding specialist, you can enjoy all the benefits of working in the health care industry without having to expose yourself to germs, bodily fluids or the other “ick” factors often associated with actual patient contact.

5. You will work in a professional environment. You will likely work in a physician’s office, clinic, hospital or similar environment alongside highly educated professionals. Or you may work for an insurance company in an organized corporate atmosphere.

6. You may be able to work from home. Like medical transcription, medical billing and coding is a specialty that can also be performed from the convenience and comfort of your own home. A medical billing career is a great career for young parents or others who’d prefer to avoid the hassle and expense associated with daily commuting.

7. You may be able to work part-time. Many medical billing and coding specialists work only half days, or on evenings and weekends. Again, if you’re looking for flexibility, medical billing and coding can be a great choice.

8. Pay is competitive. Compensation will naturally depend on where you live, local market conditions, whether you work full- or part-time, and your level of experience. Nationally, the average starting rate is about $10.70 per hour, but it can be as high as $12.12 per hour in states like California and New York.

9. There’s room for growth. With time and experience, your income can more than double. Nationally, top-tier medical billing and coding specialists average more than $56,000 per year, and more than $58,000 in higher-wage states.

10. Your skill set is transportable. Are you a displaced worker or changing careers? The skills you acquire in medical insurance biller and coder can allow you to transition smoothly to other industries that rely on detailed documentation, such as insurance, banking and home lending.

If these benefits sound good to you, then medical billing and coding is a field you should explore further. With the right training, you could be out of school and ready to go to work by this time next year. So what are you waiting for?

[1] Source: http://data.worldbank.org/indicator/SH.XPD.TOTL.ZS

[2] Source: http://www.onetonline.org/link/summary/29-2071.00

[3] Source: http://ije.oxfordjournals.org/content/31/4/776.full

[4] Source: http://www.careerinfonet.org/occ_rep.asp?optstatus=011000000&soccode=292071&id=1&nodeid=2&stfips=36&search=Go

How do physicians choose an outsourced medical billing provider?

The best way to choose a medical billing service is to understanding the needs of your practice. After that check the accuracy and the amount of time they take for claims filing and the collection percentage.

Accuracy, timeliness and collection percentage.

Accuracy – How accurate are the claims that are going out. Do they go to the right insurance company? Do they contain all of the information necessary for payment? Do the payments go to the right lock box or bank account? Who is responsible for errors? What kinds of reports are available? Often known as slicing and dicing, what kind of accurate reporting can the vendor supply that can help the practice with productivity, planning, forecasting, etc.

Timeliness – How quickly does the information provided by the practice get turned around? What is the process for handling claims denied for timely filing? This is usually a negotiation to determine who is at fault when this happens. Making sure these terms are fair to the client as well as the vendor is key here. How soon are reports available for the practice? (Daily, weekly, hourly) How quick is the response to questions, issues, requests. How available is the vendor?

Collection percentage – Who does claim follow up? Who works denials? Percentage of clean claims that go out? How much is collected on the billed dollar? How much work does the practice do to resolve the AR and how much is taken care of by the billing company?

These are common concerns when shopping for a billing company.

What is MACRA and MIPS?

What is MACRA?

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MACRA is the Medicare Access and CHIP Re-Authorization Act. MACRA replaces the current Medicare reimbursement schedule with a new pay-for-performance program that’s focused on quality, value, and accountability. The Centers for Medicare and Medicaid Services (CMS) stated that MACRA enacts a new payment framework that rewards health care providers for giving better care instead of more service.

President Obama signed into law the Medicare Access and CHIP Re-Authorization Act (MACRA) on April 16, 2015. It passed with a 392 to 37 vote in the House of Representatives, and a 92 to 8 vote in the Senate. That bipartisanship indicates the legislative support for MACRA and the significance of the bill in U.S. healthcare reform.

MACRA combines parts of the Physician Quality Reporting System (PQRS), Value-based Payment Modifier (VBM), and the Medicare Electronic Health Record (EHR) incentive program into one single program called the Merit-based Incentive Payment System, or “MIPS”.

 

What is MIPS?
MIPS is the name of a new program that will determine Medicare payment adjustments and is an acronym for the Merit-Based Incentive Payment System. Using a composite performance score, eligible professionals (EPs) may receive a payment bonus, a payment penalty, or no payment adjustment.

The Composite Performance Score is based on four performance categories:

  • Quality
  • Resource use
  • Clinical practice improvement activities
  • Meaningful use of certified electronic health records (EHR) technology

Performance for MIPS will start on January 1, 2017 and will annually measure eligible providers in four performance categories to derive a “MIPS score” (0 to 100). The MIPS score can significantly impact a provider’s Medicare reimbursement in each payment year from -9% to +27% by 2022. The four performance categories are weighted:

50% for quality (PQRS/VBM)
25% for Meaningful Use
15% for clinical practice improvement
10% for resource use

The points provided for each category will shift over time to place an increasing focus on more resource use.

 

What should I be doing now to get ready?

The best way to get ready for MACRA and MIPS is to satisfy Meaningful Use Stage 2 requirements and continue to work on achieving PQRS requirements. CMS has stated that providers already attesting to Meaningful Use and PQRS will likely have no net new requirements. mips-macra-next

The MIPS proposed rule is expected in the summer of 2016 and the final rule is expected in November. The final rule will determine how points are earned within each component.