Program Overview

720 Hours/12 Months/Mentor Supported

In most cases, the medical billing process starts with the office visit when a doctor or member of his/her staff creates or updates the patient's medical record. This record contains a summary of the nature of the illness, examination details, medication lists, diagnoses, and suggested treatment as well as relevant demographic information, most notably information about insurance coverage.

At the first visit, the provider typically gives the patient one or more diagnoses in order to coordinate a plan for treatment. The extent of the physical examination, the complexity of the case and the patient's history are then evaluated to determine the correct level of service that will be used to bill the insurance company. It is this proposed level of service that is translated by the medical billing and coding staff into a standardized five-digit procedure code drawn from one or another industry-standard database. No claims processing can take place without this coding procedure in place.

Once the procedure and diagnosis codes are determined, the medical biller transmits the claim to the insurance company or payer, usually in an electronic format (although about 30% of medical claims still get sent to payers using paper forms). Thus, it should be clear to anyone entering the profession that medical billing and coding depends to a considerable extent on knowing the ins and outs of various kinds of specialized software. Indeed, as a result of both the desire for ever more efficiency as well as the need to be compliant with a number of federal regulations, software companies and medical offices spend thousands of dollars on new technology on a continuing basis.

Approved claims are reimbursed for a certain percentage of the billed services. These rates are pre-negotiated between the health care provider and the insurance company. Failed claims are rejected and notice is sent to the provider who must decipher the message, reconcile it with the original claim, make required corrections and resubmit the claim. The exchange of claims and rejections may be repeated multiple times until a claim is paid in full, or the provider relents and accepts an incomplete reimbursement. The frequency of rejections, denials, and overpayments is high (often reaching 50%), mainly because of the complex nature of some claims and/or errors due to similarities in diagnosis and their corresponding codes.

In order to be clear on the payment of a medical billing claim, the health care provider or medical biller must have complete knowledge of different insurance plans that insurance companies are offering, as well as the laws and regulations that preside over them. Large insurance companies alone can have up to 15 different plans contracted with one provider. When providers agree to accept an insurance company's plan, the contractual agreement includes many details, not just fee schedules, which dictate what the insurance company will pay the provider for covered procedures, and other rules such as those regarding timely filing of claims. All of these contractual details impact the work of the medical coding and billing staff.

Most medical billing and coding professionals work in a very pleasant office environment. The medical community embraces these team members as extremely valuable to the overall success of the medical profession. Coders are not limited to one work environment; they can enjoy different work settings. Indeed, there are many options in this medical information profession. Moreover, a study completed in 2006 by the American Health Information Management Association indicated that on average, medical billing and coding professionals earn between $37,000 to $49,000. That is a very competitive salary considering it can take less than a year of study to earn the Thomas Edison State College Online Medical Billing and Coding Specialist Certificate.

The Thomas Edison State College Online Medical Billing and Coding Specialist Certificate Program, offered in collaboration with ProTrain LLC, prepares students for a challenging career in this critical allied health field, and helps them to gain the knowledge and skills required to pass the national certification exams. The program is designed for both those hoping to enter the field of medical billing and coding as well as experienced medical professionals, such as registered or licensed vocational nurses, who are seeking to broaden their skill set and marketability in the field of health care.

Students can expect to reap the rewards of expert-created, real-world curriculum based upon materials developed by industry specialists and designed to prepare graduates for the workplace. Our program is a practical and relevant guide for the modern health care environment. It provides an overview of CPT and ICD-9-CM coding, and addresses coding issues within specific coding content areas. This course takes you through all steps necessary to code a claim correctly and link the correct codes for reimbursement for insurance carriers and government entities, as well as explains adjustments and how and when to bill patients, even what to do in cases of denial or rejection.

The Online Medical Billing and Coding Specialist Program also stresses common medical terminology, a critical part of the language used by health care practitioners. It is essentially a vocabulary that requires a uniform pronunciation, definition, and spelling of terms used by professionals. Individuals with medical terminology training are capable of analyzing and interpreting medical reports related to specific body systems.

Upon successful completion of our Medical Billing and Coding program course, students will be prepared for an entry-level position doing medical coding in a medical office setting and will be prepared to sit for the AHIMA national certification exam to become a Certified Coding Associate (CCA). The Professional Review Guidebook included in the tuition assists students in preparing for the AHIMA CCA Examination. Students use it to practice interpreting documentation and applying their knowledge in assigning codes to diagnoses and procedures for a variety of patient settings. In addition, the program offers interactive mock examination for real-world test taking practice, not to mention 24/7 access to the curriculum and interactive learning tools, allowing students to study on a schedule that fits their individual lifestyles.

If you have questions regarding the Online Medical Billing and Coding Certificate Program, go to Then select this program and either click "Contact" for the relevant Academic Advisor, or "Ask a Question" to submit your query electronically.