I'm looking to start my own Medical Billing from home business and wanted to start by getting my CPC and CCS certificates and I was wondering if anyone has ever taken online classes from AHIMA or AAPC? If so, would you recommend the coding classes? Also did you take the exam after the classes and pass? I hear so much about people not passing and I was wondering if the classes aren't really teaching what is on the exams.
Also can anyone recommend any other certificates I should apply for or exams I should take; NHA?. Organizations I should be members of? AMBA?
Any help to get me started would be greatly appreciated!!
Do you plan to work with medical charts assigning codes to diagnosis and procedures or you want get the doctors reimbursed dealing with insurances companies and patients?
If you want to get the doctors reimbursed dealing with insurances companies and patients working for yourself, then you might do this: I. Read all you could find on " How to start and run a medical billing business": you might visit all the medical billing forums by searching google and read all the related topics. Also, if you have money, purchase these books:
1. How To Start Your Own Successful Medical Billing Business by Alice Scott
2. How to jump start a successful medical billing service by Vanessa Best.
3.Home Based Medical Billing Beginners Books
4.Start Your Own Medical Claims Billing Service, Entrepreneur's Startup Series, 2nd edition.
After reading and reading, you'll have an idea. I am in process of marketing my own and this is the hard part!! You also realize that you need to know more and more as you're going like you need an other specific billing course depending on "to who you are marketing or which insurance you will be billing the most (example worker's comp) plus all the specific state regulations".
I wish you luck.
I forgot this:
1. Michelle Rimmer has also a mini-guide:'Starting Your Home-Based Medical Billing Business' which cost $5.95! It's 14 pages document (Arial 14) with the steps you should take if you want to run your business. Every step is explained very shortly:
- Decide on a business name
- Register your business
- Start-up Costs (little more detailed)
- Services to Offer
- Expanded Services
- Fees to Charge
- Contract ( very short)
2. If you decide to take a medical billing course, choose wisely. There are a ton of medical billing courses out there and the difficult thing is how to choose the right one. According to your goals, check on this:
- content (make sure that electronic billing + practice in a medical billing software are included). Some medical billing courses will teach you only how to fill out paper claims.
- who teach it? educational clearinghouse or medical billing professionals..
- refund policy
- type: for office or home based business ownership oriented?
- internship available or guide on how you get your own business started.
- ability to network with others students
3. After you took a medical billing course and you do not feel confident to start your own, you should get some real experience or hire a medical billing business coach.
If you want to start a Medical Billing business.. why are you looking at "Medical Coding" certification? These are two separate fields.
I'm not going to discourage you from getting coding credentials. I'm all for continued education. I just get really tired of the courses out there that lump these two fields together, when they should not be lumped together. There are so many differences between the two.
Medical billing handles the processing of insurance claims and posting payments against them. This field is more of an "accounting" field. When you have a business in medical billing, the codes are not your responsibility. They are provided to you by your client.
Medical billing does not require certification to perform. Medical coding does.
Medical coding consists of anatomy, physiology, terminology.
Medical billing consists of proper CMS placement, CMS submission, posting and follow-up.... accounting. Bills. Payments. Accounting!
If you are interested in medical coding, AAPC and AHIMA are worth looking into.
Medical Billing Course, LLC
To add my 2 cents.
I agree with most of what Tammy said.
Currently, there are no State or Federal laws mandating certification as a coder or a biller. Certification has two preferences: Personal preference or employer preference.
Medical coding is not medical billing and vice versa, but they go hand in hand. A Biller should have knowledge of coding and a coder should have knowledge of billing. As a coder, I need to know how to code the visit, based on carrier requirements, so as a biller, I can submit a claim that is true and correct. When I say carrier requirement, I know there are codes I cannot submit to Medicaid or Medicare, also State Workers Comp has unique coding requirements. Some State WC requirements may utilize codes based on CPT year. For years, in Florida, we had to use 1995 cpt codes, now they require current codes. I also know I cant submit critical care codes for ed provider services to Florida Medicaid. In addition, I cannot submit toe or finger fractures to Florida Medicaid.
A Medical Biller has some additional job requiements such as resolving unpaid, incorrectly paid or denied claims. Some of these may be due to coding issues. Most of my work with my last employer was working claims that the insurance company refused to pay due to coding issues. Having knowledge of coding helped overturn the carriers decisions, resulting in payments.
I once worked a claim where the carrer downcoded the claim which I had to have recoded due to the coder using the wrong codes. The coder used the new cpt manual for a decembet service. Having knowledge of coding, resulted in the coder hacving to change the claim to the correct code. The carrier disagreed, in a complaint to the regulatory authoriy, using knowledge of coding, resulted in the regulatory authority agreeing with my appeal causing the carrier to pay $2,000 on the claim and chastizing the carrier for their improper coding decisions.
A large, major insurance company once denied a $5,000 claim due to their internal coding issues. The coding department failed with 4 coding appeals. Having knowledge of both coding an billing, 3 of my appeals were denied with the 4th appeal being won. Wih each appeal, knowledge of coding had the carrier change their denial from being inclusive to being a non covered service. The final appeal, based on billing, had the carrier agree to pay the $5,000.
From a personal note, I have personally appealed some of my bills for what I felt were upcoded visits. What should have been billed, based on the documentation, should have been a level 2 visit but was "billed" as a level 5 visit. By showing these coding errors, my out of pocket requiement was reduced to what it should have been.
Earlier this week, I met with my doctor who said I was almost back to normal. he asked me if I was certified, so I sent him my documentations, which could result in a job when he says I can go back to work again. This will be to review his unpaid and denied claims for coding issues as the person he hired had no training. The person said they were trained. Now all he wants is certified coders or billers, but that is his requirement.
I commend anyone who wishes to be trained as a coder and biller siply because the more knowledge you have the better you become. You become stronger through education and certification. Again, it is not a State or Federal Law requirement. Some States may be makng it mandatory. I heard New Jersey was doing something along these lines. Also, i worked with the Federal Trade Commission who researched complaints from graduates who said the training they received didnt prepare them for the job. The FTC was able to see some of the problems we face, so it may be possible, in the future thee may be Government regulation with coding and billing training and certification, but please understand that I am not saying this is going to happen, just that it might.
Last, again, a coder is not a biller, nor is a biler a coder. Each should have knowledge of what each other does because coding affects billing and billing affects coding. The more knowledge we have makes us a better person and a better asset to our providers.
Much success to you with your career decisions