Become a Certified Medical Billing and Coding Specialist in USA

7 mins read

Health care coverage has grown by 87 percent over the last two years, and will continue to grow exponentially over the next year becauseof the implementation of the Patient Protection and Affordable Care Act. Signed into law in 2010, according to the U.S. Department of Health and Human Services, the ACA is designed to offer health care coverage to everyone at affordable rates.

The number of people with health insurance coverage increased exponentially after January, which means that more people than ever before will begin using medical services, start seeing doctors, and getting medical testing done, in addition to getting treatment for a wide variety of ailments. This leaves a world of opportunities for budding entrepreneurs. Why not start a medical billing service company?

Why Billing and Coding?

What people don’t realize is that running a doctor’s office is much like running any other business, and both are all about the numbers. A patient doesn’t see a doctor without the nurse writing a number next to the chief complaint of the patient. The doctor doesn’t order a test without writing a number next to its name.

More specifically, from the lab work ordered to check for cholesterol levels and the MRI to check for tumors to diagnosing what ailment someone has, everything a doctor or nurse writes in a patients’ chart has a specific number appended to it. This numerical code is crucial to identifying what disease or diagnosis patient has, what type of testing the patient has been through, and what type of procedures a patient needs, and the codes are related directly to the insurance companies’ codes for rendering payment to the medical office, hospital, or other health care facility.

Because insurance companies reimburse at a different rate for each procedure or diagnosis, attention to detail is an important aspect to the job, as is legible handwriting and accurate keyboarding to transcribe the handwritten codes into the computer and the insurance claim. Writing or typing the wrong code can mean a delay in payment while the doctor, nurse, and insurance adjustor try to figure out what went wrong.

Starting a Medical Billing Service

With the ACA about to go into its open enrollment phase in October 2013, and with full coverage beginning on January 1, 2014 – although the business mandate has been delayed until 2015 – there is no better time to get into the medical and other health care related fields than now. Starting a medical billing service is competitive, but highly rewarding due to the constant demand of health care.

To become a medical billing and coding specialist, you must study in a certified diploma or a certificate program that can help you prepare for the two entry-level industry certifications that most offices require of medical coding professionals. These include the Certified Coding Associate and the Certified Professional Coder certificate.

Studying for the coding and billing profession and certificate examinations, you will learn such topics as:

  • How to maintain patient records both off and online
  • What the Health Insurance Portability and Accountability Act is and how to make patient records and other paperwork comply
  • The billing process – how to bill insurance companies and patients
  • The coding process – both ICD-9 and ICD-10 code sets, or ICD-9 at very least

As for the code sets, most doctor offices and insurance companies are preparing for the ACA, and are transitioning from using ICD 9 to using ICD 10. This means that even experienced billing and coding experts may have to go back to school to learn the new code set in addition to other new requirements brought on by the ACA.

The entire training process can take as little as four months, or as many as you need to complete your training, take the exam, and still have time for your life outside of your studies. Once you’ve completed training at the accredited facility, you can take one or both of the certification examinations, after which you can begin working at the medical office of your choice, whether it is in a hospital, a physical therapists’ office, a pediatrician’s office as a professional billing and coding specialist.

Alternatively, you could further your studies even more, and complete even more advanced billing and coding training. Now is the time, and the medical industry is the place.

Turning Your Specialty Into Business

According to, hospitals will pay around $2-3 dollars for each claim processed to them. You must go through the proper steps of starting a business – after establishing your name, contact local hospitals for business.

The trick to profiting from medical billing and coding is to produce a high volume of work. If you are comfortable making around $40,000 a year, you can try to work on your own. If you’re looking to expand your company and make a larger profit, you may need to outsource your work.

Medical billing and coding is a profitable business for any budding entrepreneur looking to start off. What advice do you have for those looking to specialize in a billing service?

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