Welcome Spring 2012 MEDICAL BILLERS!
Medical Claims Class Resources
Presentations:
Course Intro Click here
Course Syllabus Click here
Spring Course Calendar Click here
Adult School Calendar Click here
Great Article on Interviewing Medical Billers Click here
Textbook Student Website for Extra Credit Quizzes (PRINT don't Email!!!!!) Click here
Indeed.com Job Search link Click here
Online Textbook Price Search Click here
Simple Timeline of Affordable Care Act ("Obama Care") Changes Click here
AMA Summary of Healthcare Reform Click here
AMA's Detailed Articles on Healthcare Reform Click here
Advocacy: Health Insurance Finder Click here
HIPAA Powerpoint Presentation Click here
ICD-9-CM Powerpoint Presentation Click here
Advanced ICD-9-CM "Tough Spots" Click here
ICD-10-CM and ICD-10 PCS Website Click here
E/M and Surgery Coding Presentation Click here
Evaluation/Management Presentation #1 Click here
Evaluation/Management Presentation #2 Click here
E/M Computer/Calculator 1995 Rules Click here
E/M Calculation Form 1995 Rules Click here
E/M Calculation Form 1995 Rules Click here
E/M Calculation Form 1997 Rules Click here
NCCI Edits and How to Use Them Click here
Medicare Fee Schedule (modifiers, codes, allowances) Click here
California Medi-Cal AEVS phone verification (SAMPLE) Click here
CPT Surgery Global Periods Click here
California Worker's Compensation Billing Click here
California Worker's Compensation OMFS Click here
Insurance Payments - RAs/EOBs Click here
Patient Billing and Collections Click here
Hospital Billing Overview Click here
The Joint Commission's DO NOT USE Abbreviation List Click here
Claims Compliance - CCI and Fee Schedules Click here
Patient and Insurance Information and Balance Billing Click here
Related PowerPoint Presentations Site Click here
Job Search Sites - from AAPC Chapter Webpage Click here
Frequently Asked Questions
WHAT IS MEDICAL INSURANCE BILLING?
Our American healthcare system is extremely complicated and a medical billing clerk wears many, many hats!
Medical billing is a form of accounting with the added aspects of coding, complicated and very inconsistent insurance contracts, issues of medical ethics, state and federal regulations for handling of confidential records, strict laws governing the billing of taxpayer-funded programs such as Medicare and Medi-Cal, and a general knowledge of medical treatment, anatomy and medical terminology.
WHAT QUALIFICATIONS DOES THE INSTRUCTOR HAVE?
Thomas Fitzsimmons is a Certified Professional Coder (CPC) and also a Nationally Certified Insurance and Coding Specialist (NCICS). He is a member of the American Health Information Management Association (AHIMA), the California Health Information Association (CHIA) and the Woodland Hills Chapter of the American Academy of Professional Coders (AAPC). In addition to having consulted for small physician practices and billing services, he has processed all types of medical claims for Blue Cross of California Individual Services, the Tenet Healthcare hospital chain, and for the claims administrator Meridian Healthcare Management. As a claims consultant, he has worked for Kaiser Permanente, Motion Picture Health, and Blue Shield 65 Plus, and The Travelers Worker's Compensation to name a few. He edited the Medicare provider newsletter and the Medicare Provider Billing Manual during his six years as a Training Specialist at Transamerica Occidental Medicare. He has also taught Medical Insurance Billing and Health Claims Examining at American Career College, and was a Long-Term Disability Benefits Determination Specialist at VPA, Inc. (now Sedgwick Claims). In the four years he has taught at the Simi Valley Adult School and Career Institute he has certified over 200 students in Medical Insurance Billing. Mr. Fitzsimmons currently is pursuing further credentialing through AHIMA, and also teaches part-time at a Kaplan College campus.
CAN I WORK FROM HOME WITHOUT EXPERIENCE?
"The Federal Trade Commission (FTC) has brought charges against promoters of medical billing opportunities for misrepresenting the earnings potential of their businesses and for failing to provide key pre-investment information required by law... The ads lure consumers with promises of substantial income working from home full- or part-time - "no experience required." They direct consumers to call a toll-free number for more information."Click for > FTC FRAUD ALERT!
Technically, the answer is yes. However... it's doubtful whether your employer or clients would hire you to work at home without previous job experience, and there are many people who have lots of experience who are not working from home. With that said, ask yourself, would you hire somebody with no job experience to work solo at home without supervision on sensitive protected medical information and accounts receivable money? There is a lot of financial and legal liability with medical care and patient accounting and medical records. How would you feel if your doctor let somebody with no experience take your medical information and your Social Security number home with them?
Also, the job market reality nowadays is that when an employer decides he or she can have work done "off-site" it usually is ending up off-shore in India or the Philippines. Your best employment bet is to find employers who want the job done in the privacy and safety of their own facility. Medical providers often hire somebody without job experience as an apprentice. Remember, doctors do internships, lawyers are law clerks and junior partners before they get their own law practice. For medical billing there is no law saying you need experience, but the liabilities are pretty high if confidential information is compromised, and the losses could be high if claims are not submitted timely, or are submitted in a manner that could appear fraudulent or abusive or counter to federal and state regulations. Your being on-site actually helps maintain the integrity and privacy of the information.
WHAT ABOUT CODER CERTIFICATION?
There is also no law saying you need to be certified. However, it indicates to clients and employers you have a certain level of competence. There are different levels of certifications. Your Adult School course completion certificate is one form of certification. It certifies you have skills suitable to qualify you for an entry-level position as a medical insurance clerk.
Upon completion of the Adult School course you can also take an entry-level certification examination called NCICS (National Certified Insurance and Coding Specialist) offered by the NCCT (National Center for Competency Testing). NCCT provides testing certifications for those graduating from vocational programs, such as phlebotomy and medical assisting. Various school locations proctors the NCICS certification exam (ask your school or call NCCT for locations). The exam costs around $100 for recent students to take. It certifies you have entry-level skills. Your course completion certificate also certifies entry-level skills. But the letters NCICS after your name looks impressive. For details, see http://www.ncctinc.com/Certifications/
The AAPC (American Association of Professional Coders) offers a highly respected advanced certification called the CPC (Certified Professional Coder). AAPC has a student membership rate. For more information see: http://www.aapc.com/certification/cpc.aspx
The CPC is beyond the scope of Adult School or Community Services Extension courses, as it is an advanced level exam, with many questions regarding coding, anatomy, government regulations and medical terminology. Obtaining a CPC is not easy for a beginner; there are some prep courses available and a study book by Carol Buck (CPC Coding Exam Review).
The AAPC will not award a full CPC to someone without at least two years of full-time job experience coding or a combination of a certificate of course completion and one year of experience coding. This is roughly what it takes to reach an intermediate level of proficiency. If you pass their exam with no experience (which is hard to do) they will award your certification as an "apprentice" level until you actually have the two years of full-time job experience or a year with a coding course completion certificate. Please visit their website if you need more information about them. To confirm your job experience they require a letter on employer letterhead confirming your job description and length of employment.
FACILITY CODING - Hospital Coders make more money and, therefore, need more training and more credentials. The certifications or credentials are issues by the American Health Information Management Association (AHIMA).
The Certification for a beginning Hospital Coder is the Certified Coding Associate (CCA). This is an entry-level skills certification, and would allo someone to enter the hospital coding arena as a beginner. Do not let the word "entry-level" mislead you; only about 65% of those who took the CCA exam in the years 2007-2009 were able to pass the first time. (http://www.ahima.org/certification/cca/documents/2007_2009_CertificationExamPassRates.pdf)
The more comprehensive Hospital Coder certification is the Certified Coding Specialist (CCS), which demonstrates mastery of the hospital coding process. This is a high-level test and should be completed only when you have taken courses in anatomy, medical terminology and have experience coding. Of those taking the CCS exam in the year 2010, 48% passed the first time. More info Click HERE
For more on AHIMA certification, please go to their website: http://www.ahima.org/certification/credentials.aspx
If you are specifically interested in programs that teach and certify inpatient hospital facility coding (Simi Adult is an entry-level program that does not teach to the level of Inpatient Facility Coding), you should find a school that is accredited by AHIMA's accreditation body, CAHIIM (Commission on Accreditation for Health Informatics and Information Management Education). Local schools accredited to teach to AHIMA curriculum include:
Santa Barbara City College Health Information Management Program
CODEMED School of Professional Medical Coding
Please note these are both rigorous multi-disciplinary programs with courses in anatomy, physiology, pharmacology and information management as well as simply using code books. They have roughly the same course outline, but SBCC's program is online distance learning, and is approximately 2,000 to 3,000 for coursework over at least two years. CODEMED is located in the San Fernando Valley and has all-day Saturday classes for approximately 13 months at a cost or just under $10,000.
WHICH IS THE RIGHT SCHOOL FOR ME?
CLICK FOR SHORT DOCUMENTARY ABOUT STUDENT LOAN DEBT
" Americans 60 and older still owe about $36 billion in student loans, providing a rare window into the dynamics of student debt. More than 10 percent of those loans are delinquent. As a result, consumer advocates say, it is not uncommon for Social Security checks to be garnished or for debt collectors to harass borrowers in their 80s over student loans that are decades old."
Look at the course content and instructional hours of the courses and not by the verbal promises of their recruiters! Many private schools actually pay a sales commission to the recruiters for admitting students. If they tell you you can code for a hospital and make $35 an hour and are not AHIMA/CAHIM accredited, they are misrepresenting the facts. Please see "certification" above for suggestions on schools accredited to certify hospital coders.
All programs are different in their hours, costs, structure and curriculum. It is very important that you find one that best suits your needs before making substantial time and money investments. The only way to do this is to compare the cost, the content and the reputation. Do not let a school sales-talk you into spending the equivalent of the price of a car without knowing what you are getting for that money. More money does not necessarily mean more education.
Please review this Department of Education announcement of new regulations of "for profit" schools that rely on student loan monies: http://www.ed.gov/news/press-releases/gainful-employment-regulations
The Simi Adult School course is an entry-level course in billing for physicians, health practitioners and medical equipment suppliers; it does not pretend to certify hospital coders. The program is a single-semester course of 16-20 sessions, a total of 60 classroom hours, with a significant amount of reading and homework from the textbook and other exercises. In this course we learn fundamentals of the whole insurance process, the medical office structure, diagnosis coding, procedure coding, government regulations, balance billing, Workers Compensation, Medi-Cal, Medicare, Tricare, Managed Care, HMOs, PPOs, etc... A full semester could be taught on each of these subjects without exhausting the various complexities they present for a specialist. I could recommend various texts and internet resources for further study beyond the scope of our 19-20 sessions. The cost for this course is approximately $220 and another $150 - $250 in text books and reference books.
DO I NEED TO BUY MEDISOFT SOFTWARE? HOW MUCH IS IT?
The Simi Valley Adult School does not sell software and it does not ask its students to purchase software. It does give a quick introduction on how to get a claim and a payment through the MediSoft software as an example on school lab computers. You can obtain free demo versions of MediSoft for practice purposes.
Not all medical offices use MediSoft. There are other similar softwares out there. If you are interested in purchasing MediSoft, it can be obtained from the various vendors or from the manufacturer at www.medisoft.com/ If you just have to have it, MediSoft costs about $300 for the basic software. However, there are limitations to the $300 version of the software. It's best for small offices without a large number of patients and with only one computer. MediSoft Advanced runs more in the neighborhood of 2,500 +. Another popular medical billing software is Lytec, which is made by McKesson, the same company that makes MediSoft. Many provider offices now use a web-based claims clearing-house called Office Ally which is free unless you only bill Medicare. It is supported by payments per claim by the insurance companies. More information can be found at www.officeally.com. Office Ally also has a web-based software that could be used instead of MediSoft or Lytec, but it is free and has limited software features.
DO I TAKE MEDICAL TERMINOLOGY CLASS FIRST, LAST OR CONCURRENTLY?
If you are a quick learner or have few other commitments, you can take them together. If you want to take them in separate semesters to give you more study time for each, you can do that instead in whatever order suits you.
You can take the medical terminology as a self-paced computer tutorial or as an instructor led semester-long lecture class. You can even buy a self-study workbook or take an online class. You have many options. But you must learn Medical Terminology to be a competent coder in the real world.
WHAT IS THE STARTING HOURLY WAGE WITHOUT EXPERIENCE?
Starting pay in medical office as a biller/coder varies. Without experience it would likely be in the range of $10-$16 per hour. You can check your local newspaper want ads, or look online www.indeed.com or www.craigslist.org to see what the opportunities are.
As an advanced level coder you could earn substantially more than a beginner. As an experienced and certified hospital coder you could earn $35+ an hour. However, hospitals do not have work from home positions, due to the complexity of the different departments reporting to the billing and coding areas and the confidentiality of records and the high dollar amount of the bills.
DO YOU OFFER JOB-PLACEMENT OR EXTERNSHIPS?
Employers in the community often send postings for entry-level jobs to your school. These postings are on a bulletin board outside of the Business Office. There are not always postings on the board, so it is a good idead to check periodically to see if a work request has come in. Obviously, you should also be checking the internet and the local Employment Development Office to see if you can find employment, as well as checking the internet for listings (Indeed.com is very helpful). Don't be afraid to network with other students. At this time the school does not offer externships, but this could change in the near future. If you are interested in unpaid work experience for resume purposes, you can explore various volunteer opportunities, and your instructor will give you a letter of recommendation and some paperwork to facilitate volunteer work. Your instructor and the career center will do what they can to assist students, but it's up to each student to make job connections. Some longer-term more expensive Medical Billing programs have more assistance with externship placement, so if this is vital to you, you might want to check out whether placement is offered by other programs such as Ventura College or Thousand Oaks Adult School. If you have more time and lots of financial aid, you could also check out Everest College, De Vry and other private schools... make sure they are reputable! Don't forget, if it sounds too good to be true, it usually is!! If they tell you they guarantee you will leave their school with a $24 an hour job right away, you could be getting a sales pitch rather than real career counseling.
Recommended Publications for Additional Study at Home
If you would like to continue your study at home, I would recommend purchase of a CPT book and an ICD-9-CM book and a textbook-workbook. Carol Buck's "Step-By-Step Medical Coding" is a very detailed look at coding, and Marilyn Fordney's "Insurance Handbook for the Medical Office" with its workbook gives much information about billing various insurance programs.
Our class uses Joanne Valerius' excellent "Medical Insurance: An integrated Claims Process Approach" published by McGraw-Hill. Valerius' book is well-written, comprehensive, and has an emphasis on what is necessary and practical, while it avoids the inaccuracies and useless trivia that mar most other texts dealing with health insurance. This book has an optional workbook for students who want to do extra credit and get in more practice. The textbook also has online quizzes and other online resources. The class textbook is about $75. Code books add another $150 in book charges. You may be able to find used code books on the internet or borrow older code books for a deposit. Our class is not long enough to cover all the chapters in the textbook, so we will cover the most pertinent and students may study other chapters at their leisure.
Once you have studied, you can take one of several national certification exams. The simplest and least expensive certification exam probably being the NCCT's Nationally Certified Insurance and Coding Specialist (NCICS). The website for NCCT is www.ncctinc.com
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