Medical Billing & Coding For Dummies

The essential guide for medical billing professionals, updated for ICD-11 standards

Medical Billing & Coding For Dummies will set you up for success in getting started as a medical biller and coder. To ensure data accuracy and efficient data processing, medical offices need professionally trained coders to handle records. This book provides prospective allied health professionals with everything they need to know to get started in medical billing and coding as a career. In addition to an introduction to the basics of medical coding, you'll get information on how to find a training course, meet certification requirements, and deal with government agencies and insurance companies. Learn about the standard practices in the medical billing industry and get up to speed on the ethical and legal issues you're likely to face on the job. This accessible guide is a great entry point—and a great refresher—for anyone interested in the medical billing and coding profession.

• Get a primer on your career options in the field of medical billing
• Learn coding practices for telehealth, viral outbreaks, and other emerging issues
• Update your knowledge of the changes between ICD-10 and ICD-11 coding systems
• Find training programs and explore your options for certification

This Dummies guide is an accessible entry point for prospective professionals looking get a jump on their new career, and current professionals intent on staying up-to-date in this flexible and growing field.

Introduction 1

Part 1 Getting to Know Medical Billing and Coding 5

Chapter 1 Dipping Your Toes into Medical Billing and Coding 7

Chapter 2 Exploring the Billing and Coding Professions 17

Chapter 3 Weighing Your Employment Options 31

Part 2 Boning Up on the Need-to-Knows of Your Profession 43

Chapter 4 Compliance Understanding the Rules 45

Chapter 5 Not-So-Strange Bedfellows Medical Terminology and Medical Necessity 61

Chapter 6 Getting to Know the Payers 87

Part 3 Becoming a Professional Getting Certified 105

Chapter 7 Your Basic Certification Options, Courtesy of the AAPC and AHIMA 107

Chapter 8 The Path to Certification Finding a Study Program 121

Chapter 9 Signing Up and Preparing for the Certification Exam 141

Chapter 10 Adding Street Cred Specialty Certifications and Continuing Ed 161

Part 4 Dealing and Succeeding with Nitty-Gritty On-the-Job Details 173

Chapter 11 Processing a Run-of-the-Mill Claim An Overview 175

Chapter 12 Homing In on How to Prepare an Error-Free Claim 193

Chapter 13 From Clearinghouse to Accounts Receivable to Money in the Pocket 211

Chapter 14 Handling Disputes and Appeals 223

Chapter 15 Keeping Up with the Rest of the World 245

Part 5 Working with Stakeholders 253

Chapter 16 Dealing with Commercial Insurance Claims 255

Chapter 17 Caring about Medicare and Medicaid 267

Chapter 18 Coding Ethics Being an Advocate for Your Employer 281

Part 6 The Part of Tens 297

Chapter 19 Ten Billing and Coding Mistakes and How to Avoid Them 299

Chapter 20 Ten Acronyms to Burn into Your Brain 305

Chapter 21 Ten (Plus One) Tips from Billing and Coding Pros 311

Glossary 317

Index 325

Karen Smiley, CPC, is a certified coding expert in physician and out-patient reimbursement with an extensive background as a coder, auditor, and accounts receivable manager.

An essential guide to starting a career in medical billing and coding.

Health care is growing by leaps and bounds, and every medical office, hospital, and urgent care center needs at least one medical billing expert. This up-to-date guide walks you through everything you need to know to get started in an exciting new field, showing you how to find a medical coding certification course, deal with government agencies and insurance companies, and more. From understanding medical terms and keeping systems working smoothly to getting familiar with everyday ethical and legal issues, Medical Billing & Coding For Dummies is your entry point into a fun and rewarding new career.

Inside…

• Learn coding practices for telehealth
• Track viral outbreaks and diseases
• Understand the Medicare Physician Fee Schedule
• Keep medical offices running smoothly
• Discover the latest certification requirements and training programs
• Navigate the latest technologies
• Keep your skills sharp and current