A Medical Billing and Coding Salary Comparison

Many people just starting to consider an administrative career in the healthcare industry are attracted by the fact that medical billing and coding is one of the fastest growing sectors over the past ten years. But once their research gets under way, it soon becomes obvious that aiming to earn a medical billing and coding salary isn't as straightforward as it seems.

The thing is, medical billing and coding, although closely linked, are in fact entirely separate disciplines. And once this fact becomes apparent, the inevitable question arises as to whether a medical billing salary is on a par with a medical coding salary, or whether one pays better than the other.

Comparison of a Medical Billing and Coding Salary

Firstly, we need to be clear as to what are the differences between the two areas. After all, if you are more comfortable dealing with numbers than people, then maybe you should aim to qualify as a medical coder.

Whereas, if you would rather pull your fingernails out than spend your working life manipulating numerical data, then you would be more comfortable with the duties of a medical biller.

Duties and Responsibilities

A medical biller is more akin to being a practice manager than a practice accountant. Whilst the task of compiling and submitting the required invoices to medical insurance companies or direct to patients, your job will involve patient liaison to a large degree.

From making appointments, greeting patients and their families to dealing with doctors, physicians and healthcare specialists, the job of a medical biller requires a far higher degree of people skills than maybe a medical coder does.

Certainly, a working knowledge of medical codes is essential for compiling patient records and accounts, but a specialist medical coder will be far more focused on data and numerical work than in dealing with doctors and patients.

So what is the implication for a difference in a medical billing and coding salary?

Initially, new employees in their first job after gaining their qualifications, be that in billing or coding, can expect to earn roughly the same amount. An hourly rate of between $10 - $14 is usual and is only influenced by whether the position is with a large or small organization and whether that organization is situated within a major city or rural town.

Once an amount of experience has been gained, the two disciplines begin to pull away from each other slightly. Certified medical coders with commensurate experience enjoy more satisfying salary levels than their unregistered and inexperienced counterparts. An average medical coder could reasonably hope to earn anywhere between $35000 - $45000 per annum.

A similarly qualified and experienced medical biller may find that their earning capacity is slightly lower at around $32000 - $43000 pa. However, those with specialization and experience encompass both areas are best placed to reach a salary level of up to $50000 pa or even higher. The inevitable conclusion to be drawn is that is you wish to earn a good medical billing and coding salary, then your best course of action is to qualify for both disciplines.

Prepare for a Career As a Medical Insurance Biller and Coder

It would be virtually impossible for hospitals, physicians and other health care facilities to operated efficiently without the assistance of professional medical insurance billing and coding professionals. Medical insurance billers and coders are distinguished by two hugely important roles within the medical coding environment.

What Does A Medical Biller and Coder Do?

Medical insurance billers and coders manage patient records, insurance billing, accounting and database entries. Medical insurance billers and coders working in the front office apply skills without having to work directly with patients.

The medical coder career field is perfect for someone who wants a job analyzing data and thinking about how to code a various items. The medical coder spends most of his/her time assigning codes for various medical procedures. Every medical diagnosis or procedure within a health care facility must be assigned a proper code so that the office can file for reimbursement from an insurance company. Medical billing coders can work in doctor's office, hospital, or other health care office. Some medical coders can work for agencies that take work from nearby medical clinics that outsource the work to them.

Every medical diagnosis or procedure within a health care facility must be assigned a proper code so that the office can file for reimbursement from an insurance company. Medical coders can work in doctor's office, hospital, or other health care office. Some medical coders can work for agencies that take work from nearby medical clinics that outsource the work to them.

Qualify to Pursue Multiple Medical Insurance Biller and Coder Career Paths

Medical insurance billing and coding is a stimulating field that requires individuals to be extremely detailed oriented. They must also be able to quickly adhere to industry norms. Errors that lead to underpricing a service or product, coding incorrectly, or missing a charge or payment can often lead to losses in a medical practice's income. The need for error-free coding places a high premium on coders who are highly proficient in their profession.

Career opportunities for medical billing coders include, but are not limited to, doctors' offices, medical billing agencies, health care clinics and medical facilities.

Medical Insurance Billing and Coding Certification

A number of employers prefer to hire candidates with certification credentials. A certification can help assure employers that prospects posses the necessary qualifications and skills to be successful on the job.

Experience gained on the job, along with a certification, can help prepare an individual to advance into management positions or health care areas that require specialty expertise.

How CPT Code 99355 Can Help You Capture Extra Time Spent With Patients

We have previously discussed using prolonged visit code CPT 99354 for prolonged patient visits. Today we will be discussing another CPT code that will help you capture revenue for the time you spend taking care of seriously ill patients in your office. That code is CPT code 99355.

CPT 99355 can be used when you are spending more than the standard amount of time you would normally spend with a patient. For each additional 30 minutes of face-to-face time spent with a patient, you can bill code CPT 99355. You will, however, need to list this code separately in addition to the code used for the prolonged physician service.

Many physicians do not use CPT code 99355. If, however, you are spending the extra time caring for a patient you do deserve to be compensated for your services. Just make sure that you document your time properly and provide the necessary Medical Necessity components when using the code.

According to the Medicare Manual, you must document the date and the start and end times of the time you spend with a patient. Only the time you spend with the patient counts. The time your staff spends with a patient cannot be billed with code CPT 99355.

The amount of time you can receive by billing with CPT 99355 will vary depending on the region of your practice. The average reimbursement amount for this code is in the range of $95.00.

Understanding Your Options

If you are caring for a seriously ill patient, you deserve to be paid for the extra time spent with that patient. For example, if you are treating the patient in your office and are spending a significant amount of time with the patient deciding what the best course of care will be, you have a few options for capturing this time.

If you spend more than 40 minutes with this patient and the visit meets all of the criteria, you can bill for a 99215 visit. If, however, you spend another half an hour with the patient above and beyond that 40 minutes, you can bill with CPT code 99354. Additional half hour increments can be billed using CPT code 99355.

An Uncommon Occurrence

It is not common for physicians to spend more than two hours with a patient, but it does happen on occasion. When it does, you deserve to be compensated for this time. This is why it is important to understand CPT code 99355.

Documentation is Key

While CPT code 99355 can help you capture the revenue that would otherwise be lost when spending extra time with patients, you must document your patient visits properly. This means recording the start and end time of the patient's visit as well as any face-to-face time spent with that patient.

Let's say, for example, that a patient comes into your office with a flare-up of COPD. You may start the patient with an oxygen treatment in your office while performing your physical and medical decision making and your medical history documentation. You are also spending time reviewing medical records and deciding the proper course of treatment. Let's say you then decide that your patient needs a nebulizer treatment and you leave the room to see another patient. You need to document the time you spend with that patient up until the point you leave the room. The clock stops once you are no longer in front of the patient. Once you return to the room with the patient, the clock starts again.

For all of the extra time you spend with a patient, you can continue to accrue time towards CPT code 99354. If additional time is spent above and beyond that code, you can accrue time towards CPT 99355.

Time is Money

With today's economic struggles and financial cut-backs, proper billing can make or break the financial well-being of a medical practice. Because of this, you need to ensure that you are capturing as much revenue as possible for your medical practice. If you are providing a patient with extensive care, you deserve to be compensated for the time spent. You owe it to yourself and your practice to maximize your revenue, and that means billing with code CPT 99355 when the situation warrants it.

Just how much of a difference can CPT code 99355 make? Let's say you only billed using code CPT99214 for a visit with a seriously ill patient. You would generate approximately $90.00 for 135 minutes of your time spent. If, however, you spend 135 minutes with a patient and bill using code CPT 99215, CPT 99354 and CPT 99355, you would be able to generate $120 plus $95 and an additional $95 for a total of $310. That is more than three times the revenue you would have generated using the lower CPT code. You owe it to yourself and your practice to use these codes whenever possible and maximize the revenue brought into your practice.

Using Medical Necessity Effectively When Coding Patient Visits

Proper billing and coding practices can make or break the financial well-being of a medical practice. Understanding the rules that pertain to billing and coding can increase the revenue generated for your practice and can alleviate concerns regarding level of service requirements.

Physicians spend years obtaining the education that is necessary to practice medicine, but the billing and coding of medical claims is not a standard part of the medical curriculum. The fact of the matter is, understanding billing and coding is as crucial to the financial well-being of your practice as your medical education is to the physical well-being of your patients. Whether your practice has an in-house employee handling your billing or you outsource your billing and coding to a professional agency, you as the provider are ultimately responsible for the level of care you provide to your patients.

The evaluation and management (E/M) codes used in medical billing can be a significant source of revenue for your practice. While you, as a physician, understand the concept of Medical Necessity and you believe that you are providing your patients with necessary medical care, why is it that you are denied payment for a visit or a procedure that is considered unnecessary by someone who is not a medical professional? How is it that this person can judge whether or not the treatment was necessary when they were not there at the time of the visit?

The idea of Medical Necessity is a cloudy concept. It is described in less detail than many of the other coding definitions. Because of this, you should familiarize yourself with the concept of Medical Necessity if you hope to avoid denied claims and delays in payments to your practice. If you want to prevent denied claims and payment delays, you must ask yourself some questions...

What Constitutes Medical Necessity?

There are three components to the E/M guidelines including the patient history, physical exams and medical decision making. The determining factor in the level of care that you provide to a patient is the Medical Necessity component. This is also the deciding factor in how that level of care is billed to the patient's insurance provider.

Different insurance companies may have specific definitions of Medical Necessity. Medicare guidelines are what most insurance companies follow in regards to paying a claim. According to Section 1862(a) (1) (A) of the Social Security Act, Medicare does not pay for services that are not reasonable or necessary for the diagnosis or treatment of an injury or an illness or to improve the functioning of a malformed body member.

The AMA Model Managed Care Contract is a sample contract used to help physicians negotiate with health plan providers. This contract suggests that the definition of Medical Necessity is services or procedures that a prudent physician would provide to a patient in order to prevent, diagnose or treat an illness, injury or disease or the associated symptoms in a manner that is:

a) In accordance with the generally accepted standard of medical practice.
b) Clinically appropriate in terms of frequency, type, extent, site and duration.
c) Not for the intended for the economic benefit of the health plan or purchaser or the convenience of the patient, physician or other health care provider.

What Does Medicare Say about Medical Necessity?

According to the Medicare Claims Processing Manual, Medical Necessity is defined as "The overarching criterion for payment in addition to the individual requirements of a CPT code. It would not be medically necessary or appropriate to bill a higher level of evaluation and management service when a lower level of service is warranted. The volume of documentation should not be the primary influence upon which a specific level of service is billed. Documentation should support the level of service reported."

What this tells us is that a provider is allowed to bill as high as the Medical Necessity warrants as long as the physician properly documents the office visit and meets all of the History, Physical Exam and Medical Decision Making criteria. If, however, the care that is provided to a patient is above and beyond Medical Necessity, the physician can only bill as high as the Medical Necessity warrants.

Putting the Pieces Together

There is one determining factor when navigating the murky waters of Medical Necessity and that is having a clear medical reason to perform a service or procedure. If there is clear medical need for the service or procedure that you are performing, then the Medical Necessity requirements will be met. For example, if you have a patient who comes into your office with difficulty breathing, you would absolutely have to perform a comprehensive medical history in order to address the issue. Each component of that history, such as the ROS, HPI/CC and PMFSH would be needed to obtain clinically relevant information.

The HPI you perform would help you obtain the information needed regarding the patient's current condition including the duration and timing of the symptoms. The ROS would then help you determine which systems are being affected by the condition and which diagnoses could be considered. At this time you would also learn about risk factors that could contribute to the patients current condition. All of these components would be medically necessary in order to provide the patient with a proper diagnosis and effective treatment, thereby meeting the requirements of Medical Necessity.

Now, let's say the same patient comes back to your office for a follow-up visit a few weeks later after being treated in the hospital for pneumonia. The patient has no particular complaints and seems to be doing well. You would not be able to justify a comprehensive medical exam at this point because there would be no clear Medical Necessity to perform one.

As a rule of thumb, consider whether or not the services you perform will help you modify or contribute to a patient's current visit or therapy. If not, then it is not medically necessary and does not meet the Medical Necessity requirements.

Medical Decision Making vs. Medical Necessity

Many physicians confuse Medical Necessity with Medical Decision making. In order to eliminate this confusion, it is easiest to consider the Medical Necessity component as a part of the Medical Decision Making process.

There is no denying that Medical Necessity is a vague and poorly-defined concept. It is open to different levels of interpretation and, in the end, the final determination regarding whether or not something was medically necessary is up to an individual who is not even a medical provider and was not present at the time of the service. Because of this, it is important that you document the intensity of the visit as well as the key components in order to code your visits properly and maximize your practice's incoming revenue.

Getting Paid for PT/INR Office Testing With CPT Code 99211

Many doctors understand how to code properly for their time spent with a patient, but the waters become murky when it comes to coding for the time that their nurses spend on face-to-face visits. This is largely why CPT code 99211 is often underused.

As a general rule, CPT code 99211 is a "nurse code" that is used to bill for time that your practice's nurses spend with your patients. Some physicians wonder if it is appropriate to use CPT 99211 for face-to-face time spent with patients and, if so, how it should be used.

Using Code CPT 99211

According to the Medicare guidelines, even though CPT 99211 does not require a physician to be present in the room with a patient at the time of the visit, the service must be performed face-to-face with one of the physician's staff and the physician must be immediately available during this time. The visit must also have an impact on the patient's care, such as a change in medical regimen in order to be eligible for CPT 99211 coding.

To determine whether or not a visit can be billed for using code CPT 99211, there are some questions you should ask yourself:

1. Were you, the physician, on site when the visit with the patient was conducted?

2. Was the visit pertaining to a service that was medically necessary and was there a change in medical routine as a result of this visit?

3. Was the patient physically in your office (not on the phone) and did you or your staff have face-to-face contact with the patient during the visit?

Whether or not you can bill using CPT 99211 will depend on the answers to all three of these questions. If you can answer yes to all three of above questions, then the visit you are billing for will likely meet the requirements to capture revenue using code CPT 99211.

The following scenario is an example of when CPT code 99211 could be used effectively for PT/INR testing in your office...

Let's say you have a patient who is taking Coumadin/Warfarin Sodium. This patient comes into your office for a routine PT/INR test. You are in the office at the time of this visit, so the visit meets the first requirement for CPT 99211 coding.

Your nurse performs the PT/INR test and shows you the results of the test while that patient is still in your office. You see that the PT/INR levels shown in the test results warrant a change in the patient's prescription dosage. Because of this, the visit now meets the Medical Necessity requirement for CPT 99211 coding.

Your nurse then returns to the patient and informs your patient of the changes being made to their prescription dosage. The nurse then documents the patient's record while that patient is still in the office. The "face-to-face" requirement has been met, again meeting the requirements for CPT 99211 coding.

Using the scenario above, you would be able to bill for this visit using code CPT 99211. Now let's look at a scenario where you would not be able to bill using CPT code 99211.

The same patient comes into your office for a routine PT/INR test. You are in your office at the time of the visit, meeting the first requirement for CPT 99211 coding. However, the test results come back normal and there is no dosage or medical regimen change. Because of this, the requirements of CPT 99211 are not being met and you will not be able to use this code for billing for this visit.

Here is another scenario where CPT 99211 would not be used...

Let's say the same patient comes into your office for the routine PT/INR test. The patient leaves your office before you review the test results and you call back later to give the patient instructions over the phone. Because the patient was not in the office at the time the results and instructions were provided, the "face-to-face" requirement is not being met and you can not bill using CPT 99211.

Remember, you must be able to answer "yes" to all three of the criteria questions if you wish to bill using CPT code 99211. If you can answer yes to all three questions, then you should, by all means, bill using the CPT 99211 billing code in order to maximize the revenue generated for your practice.

The Definition of "Time" in Regards to E/M Services

To meet the criteria of the "time" code, the visit must meet the following conditions:

· The office visit must be dominated by counseling, meaning that more than fifty percent of the time spent with the patient is spent discussing the diagnosis, the test results and treatment options available to the patient. This time can also be spent on patient education and discussing the importance of treatment compliance on the part of the patient.

· You must document the total time of the visit and must document that more than fifty percent of the visit was spent in discussion with the patient. You also need to document the nature of the patient discussion.

Remember, "time" can not be used as a descriptor for patient observation, visits to the emergency room or preventative medicine services. If a visit with a patient meets the above conditions, you can use the "time" code regardless of the level of history, exam or medical decision making made during the course of the visit.

The Impact on Level of Service

The level of service for the E/M code will not impact your billing if you spend more than fifty percent of the patient visit counseling the patient. Instead, you can choose the time element to qualify the billing of your visit. Just be sure to document that more than fifty percent of the time spent was spent in discussion with the patient so that you can properly capture the visit code.

Scheduling Family Visits

It is not uncommon for the family members of some patients to want to speak with you in your office. If you schedule visits with these family members alone without the patient present, you will not be able to bill for the time spent. While this may provide an outstanding level of customer service to your patients and their families, you do deserve to be compensated for your time. Instead of meeting with family members alone, consider scheduling family visits to coincide with a patient's scheduled appointment. If the patient is present during a face-to-face family meeting and the time spent on counseling exceeds fifty percent of the visit, you can capture the revenue for the visit as long as you properly document the progress notes.

Of course it is up to you to decide the proper way for you to discuss patient issues with a patient's family. You do need to be sure, however, that you have the proper privacy forms filled out and that you are authorized to discuss the patient's treatment with his or her family when divulging patient information.

Properly Documenting Your Time

Time can be a significant issue when you are seeing a patient to discuss a variety of concerns. Make sure that you take advantage of the rules that pertain to billing for time. By doing so, you will be able to maximize the revenue coming into your practice and will not go uncompensated for time spent counseling the patients in your care.

Converting to Paperless Records - Keeping With Electronic Health Records

More and more medical practices are converting to electronic health records than ever before. Not only are electronic health records easier to maintain, they are better for the environment and will cost your practice less in the long run.

Many medical practices overlook the costs of keeping paper charts. There are many costs involved with paper charts, such as the cost of the charts themselves and the costs associated with replacing and replenishing charts that wear out from continued use. Some practices spend more than $4,000 each year purchasing medical charts for the office. By converting to paperless record keeping, these practices can save a substantial amount of money over the years.

When you use paper charts, you must purchase new charts and inserts on a regular basis. Then you must pay for photo copy costs, toner, faxes and maintenance on the machines used for your record-keeping purposes. These expenses can add up to more than $2,000 annually. It is not uncommon for a practice to have between $5,000 and $10,000 in record-related expenses each year. If you take that money and invest it in an electronic record system, the system will eventually pay for itself over time.

Added Space and Convenience

Saved money is not the only reason so many practices are investing in electron records management. Imagine, for a moment, that you do not have to dedicate volumes of office space to endless patient files. Imagine that you and your staff will never have to search for a missing patient file. In fact, imagine that filing is a thing of the past for you and your staff.

Consider just how much time you and your staff spend each day filing records and searching for patient files. Consider how much of your practice's building space is dedicated to storing the files that contain your patient records. Now imagine those two factors are no longer an issue for your practice. That is exactly what electronic record keeping can do for your office.

Starting the Conversion Process

In theory, EMR will allow you to replace the paper charts you keep in your office. Of course, this isn't something that will happen overnight. You will need to begin the conversion process one step at a time, and the first step is recycling.

Once you have an EMR system in place, it is time to being the recycling of the paper charts that are used by your office. You can scan older patient records into an electronic database and recycle the older charts you no longer need. As new patients come in, you can begin using the EMR system to keep records for these patients, eliminating the need for paper charts altogether.

Putting Your Extra Space to Good Use

Once your files have been migrated into an electronic format, you will find that you have an abundance of space that is no longer dedicated to storing patient files. That extra space can be converted into additional treatment rooms.

Treatment rooms equate to money. These are the rooms that generate revenue for your practice. If at all possible, try to convert the space that was used for file maintenance into added treatment rooms for your practice.

If the space that was storing your patient records can not be converted into treatment rooms, do not leave the space unused. Instead, try to create work stations for staff to use for authorizations and referrals. Not only will you be saving money by converting your file management to an electronic format, you will also be generating added space for your practice and reducing stress and increasing productivity for your practice's employees.