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The Difference Between Certified Professional Coders and Medical Billing and Coding Professionals

The Difference Between Certified Professional Coders and Medical Billing and Coding Professionals

If a career in the medical field sounds interesting, but you want to work in a career that provides support services for patients, medical centers, and physicians, two possible career paths are either a certified professional coder (CPC) or a medical billing and coding professional. There are key distinctions between the two careers you should understand, so you can choose the right career path.

Certified Professional Coder

As you might guess, a CPC is a certified professional coder. The certification is necessary because a professional coder will be assigning specific medical codes to office procedures, lab tests, and other such medical services. It is important that the code is accurate and correct in order to ensure the medical practice receives the proper reimbursement from insurance companies.

Part of your coding courses program at ABC Training requires learning thousands of different codes and disease classifications. The three most common types of codes used in the medical industry a coder must be aware of and have knowledge of include:

  • ICD-10 (International Classification of Diseases) – This is the international standard of coding used for diagnosis and procedural codes.
  • CPT (Current Procedural Terminology) – This set of codes consists of the more commonly used ones in most medical practices for outpatient and medical office procedures.
  • HCPCS (Healthcare Common Procedure Coding System) – These codes specifically apply to medical services, supplies, and treatments for patients that have either Medicare and/or Medicaid.

CPCs must also have the ability to look at a medical diagnoses and patient services’ forms to determine which type of codes to assign before submitting them to the practice’s billing department.

Medical Billing and Coding Professional

This type of medical professional does not require certification. However, a detailed knowledge of medical coding processes and procedures is essential, so you can interpret and verify the code supplied by the CPC is accurate, as well as know how and where to use the code when filling out insurance claim forms.

Certified Professional Coder

In addition to filing insurance claims, a medical billing and coding professional also deals directly with insurance companies, Medicaid, and Medicare. Other job functions and duties also include:

  • Verifying and obtaining patients’ insurance information
  • Reviewing and appealing denied claims
  • Resubmitting corrected claims
  • Answering patients’ billing questions
  • Processing payments into an accounts receivable system
  • Handling the collection of unpaid medical bills and insurance claims

Both medical careers have a favorable future job outlook with job opportunities continuing to increase for the foreseeable future. However, it is worth mentioning the salary range for CPCs is slightly higher than that of medical biller and coding technicians, primarily because a CPC is certified. Typical salary ranges for a CPC are between $35,000 and $55,000 annually, compared to between $27,500 and $45,000 for a medical billing and coding professional.

Some people do decide to pursue both programs so that they have the certification required to be a CPC but, also, are able to perform medical billing tasks, which further increases their desirability to potential employers. To learn more about either medical career training program or to enroll, call ABC Training Center at (718) 618-5589 today!

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