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Medical Billing and Coding in New Jersey

When the ICD-10 medical coding system was implemented, some New Jersey practitioners worried (http://www.njspotlight.com/stories/15/09/28/new-medical-diagnoses-codes-increase-accuracy-and-room-for-error/). How would the state's many small practices fare? Fortunately there are a lot of ICD-10 resources out there. Medical billing and coding schools are training new professionals in the new standards; certification agencies are assessing their competency. Even former coding specialists can find short courses to bring them up to date.

The ICD-10 is used to code diagnoses with an unprecedented level of precision. It is also used to code procedures performed in hospital settings. There are other code sets in use in practice settings. This represents just a portion of the knowledge and skill set. Professionals who have access to sensitive data must follow HIPAA regulations. Billing specialists must be familiar with the requirements of particular payers -- and savvy with their communication when disagreements arise.

Select a New Jersey Medical Billing and Coding Topic:

Medical Billing and Coding Careers in NJ

While medical billing and coding are often regarded as a single profession, large organizations often employ a separate group of professionals for each. Medical coders may have specialized duties. They may be responsible for coding for one or more medical specialties. Their job description may include duties such as abstracting information from medical records, educating physicians about documentation, or performing audits. The following are examples of positions advertised in New Jersey in early 2017:

  • Certified Professional Coder/Appeals
  • Inpatient Coder
  • Outpatient Coder/Abstractor
  • Medical Coder/Team Lead
  • Prior Authorization Specialist- Neurology
  • Manager/Medical Coding/Billing
  • Primary Care Coder

Experienced professionals enjoy solid income, as the AAPC certification agency reports (https://www.aapc.com/resources/research/medical-coding-salary-survey/). They may have other reason to take pride in their work. Billing and coding data may be used for more than just billing insurers. The Camden, New Jersey area is well-known for the Camden Initiative, which identifies high healthcare utilizers and helps them get the support they need. The movement began with a search through claims data (http://perspectives.ahima.org/hope-for-new-jerseys-city-hospitals-the-camden-initiative/).

Billing and Coding Education Options in NJ

Prospective medical and billing specialists can decide whether they want to enter the field with a degree or with just a few courses. They can continue to train to meet new standards or work their way up to more challenging and lucrative positions. Many courses are available online.

Some employers will hire individuals with high school diplomas or GEDs. Some note that candidates should have completed formal training programs or met specific coursework standards. University Medical Center of Princeton, for example, advertised in early 2017 for a medical coder who had completed a medical coding certificate.

Some employers state that they like to see associate's degrees -- even bachelor's degrees for some positions. Many hospitals like to hire graduates of two-year health information programs. One recently advertised a high level coding position as being ideal for RNs or foreign-trained doctors.

Certification Options

Coding certification is granted by third parties. The two primary organizations are the American Health Information Management Association (AHIMA) and the AAPC. The two organizations have traditionally represented different sub-disciplines but there is a good deal of cross-over at this point. Both offer medical coding certifications applicable to multiple settings.

The AHIMA Certified Coding Specialist (CCS) has traditionally been regarded as the premier certification for hospital settings. Candidates may demonstrate examination eligibility through any of several pathways. They may document coding experience or completion of a program that includes all coursework identified by AHIMA. The program does not have to be degree-granting. Some students opt for health information degree programs. They may pursue Registered Health Information Technician (RHIT) certification en lieu of coding certification or in addition to it. Professionals who hold the RHIT can test for the CCS coding credential without demonstrating work experience or specific coding coursework.

The AAPC Certified Professional Coder (CPC) has traditionally been regarded as the premier credential for physician practices. Professionals must meet an experience requirement in order to achieve certification at the full professional level. Formal training can reduce experience requirements. It does not take a big time investment to meet minimum standards. Some organizations partner with the AAPC to offer 80-hour programs.

Many employers expect certification prior to hire. Some employers note that certification must be achieved within a set time of hire (for example, six months).

Employers reference specialty medical coding credentials less frequently in job postings. However, they do often seek professionals who have experience with particular medical specialties (for example, ambulatory surgical center). Medical coders can opt for certification in various specialties through the AAPC; this is an added validation of their proficiency. Some professionals like to hold multiple credentials, and the AAPC reports that more credentials often correlates with higher earnings.

Employers reference billing certifications less frequently than coding certifications. However, professionals can achieve certification in medical billing through the AAPC or other organizations. Some employers ask for the CPC even for positions with titles like billing specialist.

The Certification Process

Professionals earn initial certification after passing an examination (and demonstrating that they have met all prerequisite requirements). Those who test through AHIMA must provide documentation of having met all requirements before they can be granted approval to test. This is not the case with the AAPC; those who test for certifications which have an ‘apprentice” category will need to document requirements before moving from apprentice to professional status.

CCS candidates submit applications and fees to AHIMA but ultimately self-schedule through Pearson VUE. The CPC (and other AAPC examinations) are offered on set dates which will vary by location.

Additional Resources

There are ten local New Jersey AAPC chapters (https://www.aapc.com/localchapters/list-all-local-chapter.aspx). Local chapters may host educational meetings as well as examinations. The following are examples of topics scheduled for presentation by local New Jersey chapters in 2017:

  • Coding for MS-DRG/HCC/MCC/CC
  • May MAYnia Coding Jeopardy
  • How to Ace Your Next Interview

The New Jersey Primary Care Association is among the organizations that has collected ICD-10 resources (http://www.njpca.org/?page=ICD10).