Sanford-Brown Blogs

The Biggest Challenges Facing Medical Billers and Coders

May 28, 2014 General 0 Comments

The Biggest Challenges Facing Medical Billers and CodersMedical billers and coders have challenging jobs. They need to have great attention to detail as they create codes based on diagnoses, and then bill insurance companies based on these codes. Medical billers and coders are an integral part of all medical practices, and the job growth in the industry is projected to increase by 30 percent over the next decade, according to the American Medical Billing Association's director, Cyndee Weston.

But while the industry is experiencing growth, it's also about to undergo one of the biggest changes since the move from paper records to digital. The Affordable Care Act has increased insurance coverage, impacting how physicians bill insurance, and in the next year medical coders must learn and comply with a new coding system known as ICD-10. It's the first major overhaul of the coding procedure in 30 years, and keeping up with all these changes will take some effort. But by knowing what challenges to anticipate and how best to prepare for them, medical billing and coding can be a satisfying career path.

Stay in the Loop on Upcoming Regulatory Changes

Staying up to date on new mandates and regulatory changes is imperative. It can mean the difference between swift claim payments or tedious time spent following up on them. The amount of information and the learning curve for how to apply it can be high and feel overwhelming. But knowing the best way to access the right information can save time and stress.

If you're already a medical coder, be aware of upcoming regulatory changes and save time by subscribing to several important email lists so the information comes directly to you. These include:

  • The Medicare email list, and Medicare's newsroom page. You can also sign up for your state's list to receive updates that are specific to your office's needs. Generally speaking, Medicare sets the industry standard for other insurers.
  • The ICD-10 email list
  • The major insurance carriers' policy and claims information. All major insurers post this information online for billers to use, and your doctor's tax I.D. number will gain you entry to the information.
  • The social media accounts for national coding and billing organizations, such as the American Medical Billing Association (AMBA) and the American Academy of Professional Coders (AAPC), where you can scan regular updates to get educated on upcoming changes.

A change in coding from the International Classification of Disease ICD-9 to the ICD-10 coding system take effect in the next two years. Originally scheduled to start on October 1, 2014, this has been changed to October 1, 2015, giving the industry time to better prepare for the shift. This will be a major challenge and undertaking. But most coders need only know their areas of certification, such as physician coding (CPC) or medical auditing (CPMA), according to AAPC certifications. Though it's challenging, having extra time to complete training and learn the new system will make this transition smoother.

Become Fluent in a Few Kinds of Industry Software

One of the biggest challenges now is navigating technology. Fifty-four percent of offices are completely electronic in their record keeping, according to, and electronic healthcare records (EHR) will soon be the industry standard. Navigating both digital and written records creates room for error. Software, such as Medisoft or Kerio, are common in many medical offices. Get to know how to use at least two different software applications such as these; they are real time savers.

It's a challenging time in medical billing and coding industry right now, with so many foundational changes occurring. But even the biggest challenges can be offset with good preparation and a great work ethic. Knowing where to look for information, being aware of the coming changes, and being proficient in multiple software packages will help create job security and an exciting career path.

Photo credit: Wikimedia Commons


What do you think?




Terms and Conditions

By providing your mobile number, you agree to receive text messages from Sanford-Brown via its mobile text message provider.  You may opt out of receiving messages by texting the word STOP to 94576, or simply reply with the word STOP to any text message you receive from Sanford-Brown.

While CEC or its mobile text message provider will not charge end users for receiving/responding to promotional messages, depending on the terms of your mobile phone plan, you may incur a cost from your mobile service carrier to receive and respond to any promotional text messages (standard messaging and data rates/fees and other charges may apply).  Charges will appear on your mobile phone bill or will be deducted from pre-paid amounts.  Current participating/supported carriers are: Alltel, AT&T, Boost, Cellcom, Cellular One, Cellular South, Cincinnati Bell, Cricket, Element Wireless, Golden State Cellular, iWireless, Metro PCS, Nextel, nTelos, Plateau Wireless, Sprint, T-Mobile, US Cellular, Verizon Wireless, Viaero Wireless, Virgin, and more.