Working As a Medical Biller and Coder in a Hospital

By Karen Smiley

Working in a hospital may be busy and exciting, but it’s not always as dramatic as Grey’s Anatomy, especially in the “back of house,” where billers and coders do their stuff. That said, working in a hospital environment has a lot to keep you hopping.

Working in a hospital can be a rewarding experience for the coder. Hospitals are very departmentalized, with each department having its own coders. In most circumstances, the coding in a particular department is specific to a certain specialty or set of specialties, just as it would be if you were working in a physician’s office.

The difference is that the coding is for the facility, so expenses that are incurred by the facility — including drugs and implantable items such as stents or shunts, for example — are reimbursed through the hospital coding. In addition, most hospitals have a centralized billing department (or they may send the billing out to a billing company).

Hospitals are reimbursed based on diagnosis‐related groups (DRGs) for inpatient claims. This means that the admitting diagnosis is linked to the severity of the patient’s illness. The level of risk associated with the treatment can affect the level of reimbursement received from Medicare and other payers. In other words, the sicker the patient, the greater the risk, and the higher the level of reimbursement.

Don’t think that you can’t create a niche for yourself in a larger hospital setting. You can, thanks to all the smaller sub‐clinics and offices under the hospital umbrella that service the entire facility. For example, surgeries can’t happen without anesthesia (well, they could, but it wouldn’t be a popular choice!). So hospitals use anesthesiologists, who have to bill patients just like any other function of the hospital.