Medical coders assign codes to patient procedure files for proper billing to insurance companies. Certification is not legally required, but preferred by some healthcare facilities. Common codes include CPT and HCPCS. Certified coders can work in various healthcare settings or as independent contractors.
A medical coder is a healthcare administrative worker who assigns codes to patient procedure files to ensure proper billing to insurance companies. A certified coder is a medical coder who has been accredited by an accredited medical coding certification organization, such as the American Academy of Professional Coders or the American Association for Health Information Management. Medical coding certification organizations require coders to pass a standardized exam.
To qualify for certification, an organization may require the test taker to have at least a two-year associate’s degree in medical coding. Generally, coder certification exams test knowledge and skills to properly identify and code diseases, surgeries, outpatient procedures, rehabilitation therapies, and anesthesia. To become a certified coder, a medical coder will also need to demonstrate an understanding of insurance claims, how to differentiate procedures as “medically necessary” and handle insurance claim denials. Because medical coders work with patient files, they need to be proficient in medical and anatomical terminology to earn certification.
A medical coder does not legally need to be certified, but some healthcare facilities may prefer to hire a certified coder as he or she has proof of coding knowledge and competence. Coders serve as mediators between hospitals or doctors’ offices and insurance companies. Both medical knowledge and insurance are necessary for certified coders, because they must be able to translate doctors’ notes into codes for insurance companies’ policies. They convey patient-specific medical procedures to insurance companies using standardized codes entered into an insurance claim form. Mistakes in coding can result in patients having their insurance claims paid late or even improperly denied, which is why clinics often want certified coders.
Common codes used may include the American Medical Association’s Current Procedure Terminology (CPT), which are numeric codes used in most doctors’ offices. For example, if a coder needed to charge an insurance company for outpatient psychotherapy, he would enter the code 90805 into a computer program for insurance reimbursement. Coders may also need to be familiar with the Health Care Common Procedure Coding System (HCPCS), the system that Medicare and Medicaid use to determine reimbursement. To charge Medicare for an ambulance service, A0030 would be entered, for example.
A certified coder can work in a variety of healthcare settings, such as nursing homes, hospitals or outpatient clinics. They can also be self-employed and work as independent contractors for smaller and private offices that cannot afford to have full-time coders on staff. There are also opportunities for certified coders to work in law firms as resources to investigate wrongfully denied insurance claims.
Protect your devices with Threat Protection by NordVPN
