Billing & Coding: Expert Guides and Resources

Working as a medical biller and coder is a challenging and rewarding job that takes you right into the heart of the medical industry. You are the touchpoint for everyone involved in the healthcare experience, from the patient and front office staff to providers and payers. To succeed, you'll need to know how to file an error-free claim, important acronyms, and what to look for in a payer contract.

Before you start job-hunting as a medical billing and coding specialist, give some thought to what sort of environment you want to work in. The possibilities are almost endless, and if you think about your preferences before you search for a job, you can narrow down your list of possible employers, saving yourself a boatload of time.

Compliance — it’s such a serious word, and for good reason. When people in the healthcare industry speak about compliance by healthcare providers, they mean that an office or individual has set up a program to run the practice according to the laws established by federal or state governments and regulations established by the Department of Health & Human Services (HHS) or other designated agencies.

At the top of the government heap is the biggest government payer of them all: good old Medicare. Medicare is funded by payroll taxes deducted from every employed American. (You’ve probably seen the acronym FICA, which stands for Federal Insurance Contributions Act, on your pay stub. This FICA deduction is what helps fund Medicare.

The majority of medical billing and coding training programs begin with basic human anatomy and physiology, more commonly referred to as body systems. You need to understand how each organ within a particular body system works, how disease or illness affects the system, and why the treatment was necessary. Most textbooks contain diagrams specific to each body system.

So, what does a medical biller and coder do? To secure timely payment for the provider (that is, your employer or client), you’ll find yourself working and communicating with many different people. As a representative of the office, being friendly and approachable to patients and payers alike is fine. After all, the professional demeanor you exhibit toward patients, fellow office staff, your superiors, and the payers with whom you work goes a long way in helping you establish your role as advocate-in-chief.

Each vocation has its own specific terms which are widely used and medical coders and billers are no exception. A body system is a group of organs that perform a specific task. For example, the nervous system includes the brain, the spinal cord, and the nerves. Information about body systems matters to you because coding books are structured according to the body systems.

Although many people refer to medical billing and coding as if it were one job function, billing and coding really are two distinct careers. Here is a brief description of the tasks and functions associated with each job and give you some things to think about to determine which path you want to pursue: The medical coder deciphers the documentation of a patient’s interaction with a healthcare provider (physician, surgeon, nursing staff, and so on) and determines the appropriate procedure (CPT) and diagnosis code(s) to reflect the services provided.