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Significance of Medical Coding and Billing

Medical billing and coding are two of the most critical components in any medical practice. Accuracy in both of these areas is critical to patient safety, rapid payment, and efficient operations. With a major portion of health care expenses being taken care of by health insurance, there is a huge demand for accurate and reliable medical coding and billing process.

As the payment for medical services provided is directly influenced by this process, health care facilities and medical practitioners cannot afford errors in it. Failure to implement accurate medical coding and billing system proves detrimental to the administration of any health care facility. On the other hand, affordable medical claims management, when implemented, provides enhanced collectible revenue of the practice.

Difference between a medical biller and medical coder

A medical coder’s main role is to decode the service or procedure written on the patient’s documentation provided by the healthcare provider, and then determines the appropriate procedure (CPT) and diagnosis code to submit. Medical coding workers spend time in assessing and properly coding the data, in order to ensure an accurate billing procedure is free of any errors.

Then, the medical biller inputs the claims with the appropriate codes and submits the claim to the insurance company for billing. The medical biller then, follows-up with the insurance company to make sure the claim has been approved, if there are any discrepancies or missing information, they reach out to the patient and let them know what is happening with their claim.

Importance of Accuracy in Medical Billing and Coding

Accuracy in medical coding and billing prove to be crucial for medical practices for perfect and timely submission of medical claims. Error-free and timely claim submission ensures getting reimbursement and reducing accounts receivable.

Impact of Inaccurate Billing on Patients

Errors in medical billing lead to patients being put under hardship. This, in turn, enrages them. Errors may impact patients in several ways, such as having to face financial trouble, having to spend precious time on the phone for explaining things, or being pushed to pay for services that actually were not provided. Apart from causing unwanted issues, medical billing errors result in patient dissatisfaction that doesn’t go well for the medical practice at all.

Some errors that can be avoided

Careless use of balance billing:

The practice of balance billing refers to a physician’s ability to bill patients for outstanding balances after the insurance company submits its portion of the bill. Out-of-network physicians, not bound by in-network rate agreements, have the ability to bill patients for the entire remaining balance. Balance billing may occur when a patient receives a bill for an episode of care previously believed to be in-network and therefore covered by the insurance company, or when an insurance company contributes less money than expected for a medical service.

Duplicate billing:

“Double billing” (sometimes referred to as Duplicate Billing) occurs when a provider attempts to bill Medicare / Medicaid and either a private insurance company or the patient for the same treatment, or when two providers attempt to get paid for services rendered to the same patient for the same procedure on the same date.


Overcoding and undercoding are two coding mistakes that can have damaging results in the medical office. Overcoding leads to insurance companies making much higher reimbursements than what the actual reimbursement should be. However, the penalties of getting caught far outweigh the advantages of getting a higher paycheck. Undercoding can result in the loss of revenue.

Why Medical Coders are the Superheroes in the Healthcare Industry

A medical coder typically codes the claims of a physician, hospital or a therapist. Unfortunately, it is understood that the responsibility of a coder ends with coding alone.

This is not true at all!

Medical Coders do much more than just coding. The job of the coder can vary and grow to more extents, based on the facility or organization that he/she works for. The Healthcare Insurance industry can never function without them. In short, they are the superheroes of the industry.

Let us look at some of the non-coding activities performed by Medical Coders:

1. They act as mentors

The medical coders are the right people to teach and mentor the healthcare industry and the healthcare insurance industry about the coding fundamentals and guidelines. The doctors and administrators also often get coached and receive a lot of crucial information from them about the guidelines.

2. They are on a learning curve always

Getting a job in coding does not mean that the coder has an easy job to do now and he can put his feet up in the air for life. On the contrary, a medical coder has to keep learning how to code unlearn and relearn periodically. Because the coding guidelines keep changing. Like the recent one, ICD 10 transition is going to affect medical coding. Learning new codes, additional guidelines, and mentoring the same across the industry are some of the major responsibilities of the coder. A minor issue in coding can mean that the claims getting denied or underpaid, which no physician or facility appreciates.

3. Deal with the denials

Speaking about denials and underpaid claims remind yet another job of the coders. They are often left to deal with denials, as same as the billing staff. Senior coders are often part of the denial management team. If a claim faces an issue, often coding is checked and, in case of continuous denials, a coder gets into action. He or she would have to check with the insurance company, if the codes are wrong, or reassure them why the specific code is present in the claim.

4. Coders have their plateful

Now, if the coders have received the appreciation of dealing with the codes, insurance knowledge, it is time to extend the applause. For they also take time to learn about LCD, NCD, policy guidelines, HIPAA rules, State and Federal laws and much more. They come handy to them, to keep off from errors.

5. They understand what the doctors mean

Pharmacists are often valued for understanding the writings of a doctor. Next time, the coders should never be forgotten. Pharmacists have the opportunity of reading the names of the pills and medication from the boxes. Sadly, the coders have a lot of patience to decipher what the doctor has prescribed. If there are nursing assistants taking a note of the procedure and treatment process, they have a great day dealing with different set of handwritings for a single claim.

Apart from these, the best struggle of the coder can be considered to have knowledge about the case studies, surgeries, and codes. Coders are often life science background or someone who has something to do with the healthcare industry. That does not mean they can understand all these, and yet, they often are required to discuss these topics, though not a physician.

Is Medical Transcription the right career for you? Find out!

When we think of medical transcription, a topsy-turvy handwriting on a piece of paper which very few people dare to read and understand pops up in our mind. But medical transcription is so much more.

What is Medical Transcription?

A simplified definition of medical transcription goes like this – ”Medical transcription, popularly known as MT, is an allied health profession dealing with the process of transcribing voice-recorded medical reports that are dictated by physicians, nurses and other healthcare practitioners.”

What are the goals of Medical Transcription?

The primary objective of medical transcription is accessibility or the easy availability of medical information. For instance, medical records of a patient can be made easily available once the audio-visual material of procedure performed on them get transcribed. The second goal is successful online marketing. A health provider advertises its business with the help of the story of its success in different cases backed by the carefully drafted and designed fact. And the third main goal is organizing the information for further purposes of research.

How does Medical Transcription work?

Doctors, nurses and other professionals working in the healthcare sector can use computer applications such as word processors to create reports, articles, and charts etc. Many don’t have enough time, skill or the desire to learn or deal with such programmes. When they need assistance to write for official purposes, they turn to the medical transcription services.

Medical reports can be voice files, notes taken during a lecture, or other spoken material. These reports are dictated over the phone or uploaded digitally via the Internet or through smartphone applications.

Given the complexity of the procedure involved in preparing medical transcription reports, there is high demand for manpower who can render and edit reports, procedures, and notes dictated by doctors in an electronic format, in order to create files representing the treatment history of any particular patient. People who render this service are known as Medical Transcriber (MT) or Medical Language Specialist (MLS). Health practitioners dictate what they have done after performing treatment procedures on patients and medical transcriptionists, or MTs, transcribe the oral dictation and/or edit reports that have gone through speech recognition software. A confidential and up-to-date medical information about a patient is converted to a written text document by a medical transcriptionist. Healthcare providers often prefer to store medical records electronically due to the whopping volume of hospital patients and the paperwork it needs. The electronic storage gives immediate access to subsequent departments of the service provider i.e hospitals regarding the patient’s care to date, notation of medications, their allergies etc. It helps establish a history on the patient to facilitate quality healthcare delivery regardless of geographical distance or location.The transcription text may be printed and placed in the patient’s record. It may also be retained only in its electronic format depending upon the need arisen. The transcription can be done by medical transcriptionists employed in a hospital, or by people who work at home as telecommuting persons for the hospital. MTs also work as telecommuting employees or independent contractors for an outsourced service that performs the work offsite under contract for a hospital, clinic, physician group or other healthcare services provider. They sometimes work directly for the service providers such as doctors or their group onsite.

How can you become a Medical Transcriptionist?

You can easily become a medical transcriptionist by earning a certificate degree in Medical Transcription. You will study and master medical terminology, business writing, typing skills, computer applications, and legal issues on healthcare documentation. Some certification programs include internships and fieldwork opportunities, giving them on-the-job training and helping them apply what they learned in the program. The certification lasts for a certain valid period and earned by passing an examination. To maintain the certification, transcriptionists need to participate in on-going education courses.


Medical Transcription is a critical aspect of healthcare services. A certificate or associate degree in the medical transcription field is necessary and along with good experience, it can help your employment prospects.

Difference Between The AAPC CPC AND AHIMA CCS/CCA Examination

AAPC and AHIMA are certifications for medical coders.

What is medical coding?

Medical coding is the transformation of health care diagnosis, procedures, medical services, and equipment into universal medical alphanumeric codes. The need for coding arises because the medical diagnosis and procedures are complex to understand for a non-medical professional so by converting them into standard universal medical alphanumeric codes it becomes easier for professionals like insurers to understand and provide appropriate compensation. The other purpose of coding is to transform the data form suitable for computer-aided analysis. There is a huge demand for medical coders in the healthcare industry. The salaries offered to these coders are also highly remunerative. In this scenario, many certifications have come up which certify the coders who would like to make it a profession. Famous among them are AHIMA and APPC certifications.

Differences between AAPC CPC and AHIMA CCS/CCA Exam

Medical coding can be categorized into facility coding and professional coding.

AAPC stands for American Academy of Professional Coders. The aim of AAPC is to provide education and certification to coders working in physician-based settings. AAPC CPC certification is more suitable for professional coding. Professional coding is the type of coding carried out an outpatient as part of outpatient services. Some of these outpatient services require professional coding that includes emergency medicine, surgery centers, private practices etc. Professional coders are known to work mainly in the doctor’s office.

AHIMA stands for the American Health Information Management Association. AHIMA’s stated mission is to be the professional community that improves healthcare by advancing best practices and standards for health information management and become a trusted source for education for education, research and professionals credentials. AHIMA CCS certification is more suitable for facility coding. Facility coding has to do with the type of coding carried out on inpatient services. Facility coders are known to work mainly in hospitals.

Another important factor is the certification exams. For both the AAPC AND AHIMA, you’ll need to sit for and pass a very lengthy exam as a necessary requirement. The standard in medical coding is high and there is a huge demand for qualified and proficient coders.

The CCS and CCS-P exams are not considered entry-level exams. They are ‘fill- in- the- blank’ questions which are very difficult to clear, which is why they are only recommended for coders who have a few years of on- the job experience.Most of the graduates take the CPC exam because the exam includes a free retake.Typically entry-level coders begin as out-patient coders. Many times outpatient coders move into inpatient coding once they get more onsite experience because inpatient coding is generally considered a more advanced and experienced level of coding.

For this reason, a CPC credential or a CCA credential will both put you in the right position to be certified as an outpatient coder first with the potential to move into inpatient coding later as you gain more experience and additional credentials.

We hope you found his article beneficial and have made a choice about your certification exam.

5 Reasons why Medical Billing is one of the best career options in the healthcare industry

A plethora of options are available in the career market, but choosing the right one will give excellent exposure and lets you earn at leisure. Medical Coding is an excellent option in the healthcare industry given their growing demand.

If you have considered a fresh start or a career shift in the healthcare sector, then Medical Billing is an excellent choice for you. The job roles include analyzing the patient reports and records using specific codes to bill the insurance providers.

If you assume that you are not career-ready for the same, then one can seek the assistance and guidance of Medical Coding Training institutes that are training candidates who aspire to become a Medical Billing professional.

Unlike other professions, Medical Billing gives you the flexibility that makes a work-life balance.

Let us walk through various reasons, that will help you analyze why Medical billing is one of the right career opportunities for you.

1. No prior experience is mandatory: You don’t need previous experience for  Medical coding and billing. All you need is just to get certified through an accredited Medical coding Training Institute.

2. The wide range of employment opportunities: From medical healthcare institutes, hospitals, medical centers, nursing homes, administrative departments, and physiotherapy centers, there is always a steady demand for accredited Medical coding professionals.

3. The job market is welcoming: A wide range of option can be stumbled upon as you are researching the career options for Medical Coding professionals.

4. Flexibility: Most health care centers work 24/7 offering uninterrupted medical services. Hence, every health care center requires one or more medical coding employees to work during every shift. The steady demand along with shift timings gives work flexibility to many professionals.

5. Competitive Salaries: Unlike the earlier times, the growing demand for healthcare professionals in the healthcare sector have led to many opportunities and attractive salary packages for Medical Coding and Billing roles. Every year, a group of professionals land in the career market from the Medical Coding Training Institute raising the bar of competition and hence, the overall quality of medical professionals.

Conclusion: Medical Billing is a great career option for you as it offers stability, steady growth, work-life balance, exciting opportunities, and a lucrative salary.

Top Proven Strategies On Clearing CPC Exam With Ease

Examinations are always intimidating. The CPC (Certified Professional Coder) exam is no exception. The highly acclaimed certification is one step away from being a successful Medical Coding professional.  

Gearing up for your CPC Exam requires you to skim through the various materials provided by the AAPC (American Academy of Professional Coders) to crack the Medical Certification Exam. If you are out of touch with the Medical coding terminologies and terms, then it’s time to acquaint yourself with books or materials that are meant to assist you in your CPC exam.  

CPC Preparation strategies

We list a few strategies to help you come out of the examination with flying colors.

1. Planning and Preparation

Planning is the first step to thorough preparation for clearing the CPC Exam with ease. The study material is exhaustive and contains plenty of topics to be covered. It can leave you completely overwhelmed during your preparation. Focus on the CPT Manual as the questions from the CPT code, frequently appears in the paper. It makes practical sense to concentrate more on the CPT Manual as compared to other modules like  ICD-10-CM codes and HCPCS. It is essential to gear up for the exam with strong medical vocabulary. You can even amass the knowledge through review courses or flash cards to get more familiar with the terminologies. You can avail some of the preliminary exams conducted by the private firms to practice.

2. Taking the CPC Test

When you are taking the CPC Exam, following strict timelines is very important. Effective time management saves you while you decipher the Medical Coding exam. An efficient way to deal with the long paper would be to break it into smaller segments strategically. Moreover, in each section allot a time limit for yourself to finish it. In a way,  it lets you complete the exam intelligently and not waste time without a plan. Hence maintaining momentum in the CPC exam is essential. You can take mock tests and experiment with the trial and error methods to find the best way to attempt the Medical coding exam.

3. Attempt all questions

Since CPC Exam does not have any negative markings, ensure that you attempt all the questions to collate as many marks as possible. If you do not try a problem, you get zero marks for the same. Instead, take a chance and attempt all the questions. One way to make a calculated guess is to answer the easy questions first and then to move to the rest. Sticking to the time deadline specified for the exam while attempting the problems would be an ideal way to complete the paper.

4. Be strategic

Speed and accuracy are vital elements in cracking the paper. Whether it is length reports or multiple-choice questions, solve each problem by going through each choice and working out the code on your own. Power up your reading skills by following the simple rule of either memorizing or marking it on the go, which saves time on reading again.

Final Thoughts

CPC is a Medical Certification Exam that lets you pursue a career in the flourishing Medical Coding industry.  With proper preparation and practice, one can clear the CPC exam comfortably and enjoy a prosperous career in the world of Medical Coding.

5 Awesome reasons to join the Medical Coding and Billing industry

If you are thinking about a career in the healthcare industry, Medical Billing and Coding is an excellent option. We list a few reasons for you to make the switch:

1. A crucial and irreplaceable job

Medical Billing and Coding authorities are necessary for the healthcare industry as they help in minimizing expenses, lessening therapeutic slip-ups and for the most part, guaranteeing that there’s a free stream of data about the patients’ restorative narratives. They are an irreplaceable faction in the healthcare industry that keeps the health services offices running smoothly and saving lives in the bargain as well.

2. No need to graduate from a medical college

Probably the biggest obstacle for individuals who desire to work in the healthcare industry is the high cost and lengthy period of studying in a medical school. Anyone with a keen interest can learn Medical Coding and Billing in just a few months at a reputed training institute and get a professional certification.

3. Making that career switch is easy

Medical Coding and BIlling is a welcoming profession for anyone who is keen to enter the healthcare industry at any stage of their life. You can switch your career to this field with tremendous ease. You can complete the Medical billing and coding program in less than a year. After that, you can take certification exams offered by the National Healthcareer Association (NHA) or the American Health Information Management Association (AHIMA), and you’re all set a booming career ahead in this field.

4. Flexible shifts

Medical Billing and Coding work is a 24/7 job. Hence, another advantage is the option of shift timings in this profession. Whether you are a morning or night person, this is a career that is for anyone who prefers to work at their optimal capacity and time.

5. Work from home is available

A vast majority of the work is done on a PC by medical billing and coding experts. A few companies offer the choice to telecommute or work from home on some if not for all the days in a week. Thus, Medical coding and billing is an excellent career option for whom working in a typical 9-5 corporate office is not an option.

Top 5 reasons to become a Medical Coding and Billing Specialist

Being part of the medical team, Medical Billing and Coding professionals acquire an important set of skill and knowledge of various medical terminologies and anatomy, as well as proficiency in the field of Medical coding and billing software.

To meet the rising medical needs of people, companies dealing with insurance and similar criteria are continually updating their claims processing procedures, thus, fueling the job explosion for Medical coding and billing specialists.

For many, this occupation can be very advantageous. Let’s look at the top five reasons to consider before getting into this field.

Working in the healthcare industry is satisfying

You would be able to say that you are directly contributing to saving lives every day? Not really!

On a serious note though, one great benefit of getting into the Medical coding industry is the immense job satisfaction that you get. Another advantage is that is you get to complete the specialized training in just a few months.

Medical billing and coding specialists are effectively trained in reducing medical mistakes, keeping the costs down, and ensuring the free flow of information about the patient’s medical history.

These specialists are crucial in keeping the medical facilities up and running for saving precious lives.

Be a niche member of the rapidly evolving industry

Medical billing and coding are experiencing the most significant evolution today. The legislation is attempting to reform the healthcare industry by motivating more use of electronic medical records. By improving the way patients’ medical records are managed, the healthcare industry is looking to cut costs and increase revenues significantly. The nature of the Medical coding and billing job is getting increasingly sophisticated and niche with these evolutionary changes within the industry.

You are saving lives too

When thinking of life-saving work, you don’t think about the medical coders and billing professionals. For instance, medical coding errors can be deadly sometimes. This is the case when an incorrect code can lead to wrong diagnosis and treatment.

That’s why medical coding and billing professionals are essential to the industry. Making sure the data is prompt and accurate is the core part of their responsibility.

High recruitment

This is one of those rare fields that is witnessing an invariable increase in the way hiring is done. The medical billing and coding specialists are expected to see a 15% rise by the year 2024. That’s a “much faster than average” statistical figure.

In comparison, the average jobs in good healthcare countries are going to see an increase over the coming years. That translates to great things in store for medical billing and coding specialists.

Call yourself a cool ‘coder’ too

The reason might seem trivial. But if you are in India and under the pressure of having a designation of ‘coder’ before your name, this field is worth a try.

It’s true that the medical coding and billing specialists are entirely different than the software developers. Software developers write codes to develop software, wherein, you would be inputting correct codes for various medical conditions into the software. Still, let’s face it, not enough jobs have cool short versions of their titles to make you sound awesome.

If you are now curious to learn more about the subject and get into a job like medical coding and billing, then hopefully this article has given you important insights. Given the volatile nature of the profession, the field requires experienced personnel to perform the tasks on time and help patients have smooth medical treatment. Accuracy, precision, and attention are essential for the job. Hence, if you fulfill all the criteria, we highly recommend that you try getting into medical coding and billing.

5 Advices to those who are pursuing Pharmacovigilance as a Career

Pharmacovigilance (PV) or drug safety is an important aspect while assessing the risk/benefit of the various pharma products and confirming their safety for patients. It is the science of obtaining, monitoring, investigating, assessing and analyzing information from healthcare service providers and affected individuals on the side effects of the drug.

Why is Pharmacovigilance great to be opted as a career?

One of the excellent employment options for pharmacy, medical and life science graduates is getting into Pharmacovigilance. It is because of the Pharmacovigilance professionals that the drugs in the market are safe and all those which are identified hazardous are removed off the shelf. The Pharmacovigilance professional comes into the picture when any medicinal side effect is reported in proper databases and collect additional information and send reports to appropriate regulatory bodies.

How does the industry function?

Career opportunities in this field are very less, especially if you are not a doctor. Organizations related to the field are huge and their respective team is mostly located at different sites. Working in isolated departments exists for employees with very little technical exposure with the senior detection staff and risk management staff.

The Pharmacovigilance is not a management opportunity rather the employee has to work hard. The job is a little tricky expects a person to be intellectual, challenging and unexpected. If these are the qualities missing, then you must reconsider your option for joining the profession.

5 tips for pursuing Pharmacovigilance as a career

1. Consider your interest in PV

PV has multiple areas to be considered. Some are specialized jobs like Statisticians, Epidemiologists, IT and Computer experts. Therefore, think over what you are interested in.

2. Consider your educational qualification

you cannot get into PV with a normal degree. Instead, you need to have relevant education in pharmacy, medical or life science. The higher your educational qualification is, the more your opportunities would open to get into PV. The highest degrees being MD, DO, RPh, PharmD, RN, LPN, Ph.D., MS, BS, IT, Epidemiology, etc.

3. Get an experience first

Being a complex field of detection risks, most employers expect experienced candidates. Hence, if you wish to crack through your dream company and job, then make sure you have a certain number of practical experiences. This might give you an upper hand during any interview process.

4. Consider your place of work

Working in PV can offer you great prospects if you consider working for small pharma companies, sites with global activities, generic businesses and regulatory and drug safety organization. Therefore, a candidate must always try to get through these fronts to gain more knowledge and stability.

5. Build your conscience and be assertive

Being in the PV department requires you to be very attentive to minute details while analyzing risks and other factors of various drugs which are used by people. The experts are in charge of complex health information which needs to be precise and productive.

While you are on the job, you meet a lot many individuals. Hence it is required that you are self-assured and trustworthy.

Being one of the complex fields to handle in the pharma world, a lot of consideration is expected. Being a tough and critical job, patience and understanding is expected.

There are many Pharmacovigilance training centres providing Pharmacovigilance training. Try getting more knowledge on the subject before making a decision.

Scope and Future of SAS in Healthcare Industry

Statistical analysis system (SAS) is one of the most successful and popular tools used for data analysis and statistical modeling. It is one of the fastest and robust software for advanced analytics, multivariate analyses, business intelligence, data mining, data management,  report writing, statistical analysis, applications development, business modeling and data warehousing. SAS is an asset in various job markets as it holds the most significant market share regarding jobs in advanced analytics.

Role of SAS in the healthcare industry:

SAS is extensively used in clinical trial data analysis in the pharmaceutical and clinical research companies. SAS programmers play a vital role in clinical trial data analysis.

  • A SAS programmer addresses the technical needs of the healthcare industry.
  • Implementation of information technology in the healthcare delivery system helps to gain valuable knowledge from data, and insight to recommend action or guide decision making, and patient care quality improvement and practice of medicine.
  • SAS analytic solutions help achieve business goals in healthcare related to revenue generation, cost control, and strategic performance management.
  • SAS  tools are used to explore clinical outcomes and risk tolerances to improve the overall quality of patient care.

Role of SAS programmer:

Statisticians provide the methods of the data analysis, implement the analysis methods on the collected data and provide the study summary tables, graphs, and data listing to the statisticians and or clinicians to write study report.

  • SAS programmers closely work with statisticians and data managers to provide the link between raw data and the analysis.
  • In few companies, SAS programmers also create the database. SAS programmers need to write programs to read database data to SAS data sets and also generate a SAS format library.
  • SAS programmers will also write SAS programs to clean the database data according to the edit specifications provided by CDMs.
  • SAS play a significant role starting from defining the clinical study to till regulatory submission. The clinical study report is compiled using the data generated in the SAS environment.
  • SAS also plays a role in protocol development, the randomization process, CRF designing, adverse event reporting etc.

Future scope of SAS:

The clinical SAS programming industry in India has seen rapid germination in the last few decades and the trend seems to continue, for the next couple of years, due to cost advantage and the availability of skilled labor.

Due to the heightened demand for skilled resources, the wants of the programmers have taken a different shift toward diversifying exposure, unsustainable wage inflation due to multiple opportunities and high expectations around career progression.

According to a recent study, SAS analytics skills are the most valuable skills to have in today’s job market. The traditional healthcare paradigm is expanding the range of career choices for SAS programmers. To gauge the current state and future vision of healthcare analytics, SAS is has become a valuable tool.

If you feel resonated and think a career in SAS is worth considering, then drop us a line at…….. or visit www.joshimedicode.com  

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