What is Medical Coding and Insurance Billing?

A Medical Coding and Insurance Billing at the California Healing Arts College (CHAC) prepares individuals to effectively and efficiently maintain a patient’s medical record and other health and medical information. Medical Coding and Insurance Billing is an important behind-the-scenes part of our health care system. Certified Medical Coders & Insurance Billers communicate between medical offices, patients & insurance companies. By assigning letters & numbers to diseases & conditions, injuries & medical procedures, they speed up the process of payment.

Medical coding and insurance billing professionals require an ability to focus on details, and should have patience. Problem-solving skills are also useful and essential, as coders are required to determine which part of each medical report is relevant to bill / code for. Medical coders should have knowledge in the following areas:

• Blue Cross and Blue Shield Plans
• Completing CMS-1500 and Commercial Claims
• CPT Coding
• ICD-9-CM Coding
• Insurance Claim and Regulatory Considerations
• Medicaid
• Medicare
• Tricare and Workers’ Compensation

Duties performed by a coding & billing specialist may include any combination of the following:

• Appropriately filling out and filing medical insurance forms
• Assigning a code to each diagnosis and procedure

AAPC Licenses

The American Academy of Professional Coders (AAPC) offers several types of medical coding and billing certifications:

• Certified Professional Coder (CPC): To become a CPC, an individual must pass a coding certification examination sponsored by the AAPC. The examination consists of questions regarding the correct application of CPT codes, ICD-9-CD diagnosis codes, and HCPCS procedure and supply codes used for billing professional medical services to insurance companies. To sit for the exam, an individual must have at least two years of coding experience and is required to maintain yearly renewal and CEU (continuing education) requirements.
• Certified Professional Coder – Hospital (CPC-H): To become a CPC-H, an individual must pass a coding certification examination sponsored by the AAPC. The examination consists of questions regarding the correct application of CPT codes, ICD-9-CM diagnoses, and procedure codes used for billing facility services to insurance companies. To sit for the exam, an individual must have at least two years of coding experience and is required to maintain yearly renewal and CEU requirements.
• Certified Professional Coder – Payer (CPC-P): To become a CPC-P, an individual must demonstrate that he or she has the skills and knowledge to arbitrate provider claims effectively. The CPC-P certification demonstrates the payer coder’s proficiency, aptitude and knowledge within the payer environment. To sit for the exam, an individual must have at least two years of coding experience and is required to maintain the appropriate amount of yearly CEU requirements.

AHIMA Certificates

The American Health Information Management Association (AHIMA) offers the following credentials:

• Certified Coding Associate (CCA): Even without much job experience, a new coder can earn the CCA immediately in order to demonstrate competency in the field.
• Certified Coding Specialist (CCS): Certified Coding Specialists are professionals skilled in classifying medial data from patient records, generally in the hospital setting. To become a CCS, an individual must possess expertise in the ICD-9-CM coding system, as well as the surgery section within the CPT coding system. Additionally, the CCS should be knowledgeable of disease processes, medical terminology, and pharmacology.

NHA Certificates

The National Healthcare Association (NHA) offers the following credential:

• Certified Billing & Coding Specialist (CBCS): To become aCBCS, an individual must pass a coding certification examination sponsored by the NHA. The examination consists of questions surrounding administrative procedures for medical billing and insurance claim processing, as well as submitting, tracing, transmitting, and appealing billing claims for a full range of health plans.

• Group practices
• Hospitals
• Insurance companies
• Multispecialty clinics
• Nursing care facilities
• Pharmacies
• Physician offices
• Rehabilitation / Specialty centers
• Working from home

(a) Be a high school graduate or equivalent
(b) Be at least 18 years of age
(c) Be physically fit enough to perform the required tasks for your training