Medical Coding and Billing Industry Scams and How to Avoid Them

Medical coding and billing may be inherently noble professions but they’re no strangers to scams and frauds. In recent years, countless fraudulent firms have tarnished the reputation of these professions, leading to a range of misconceptions among the public.

As such, we consider it our moral responsibility to spread awareness about these scams so as to ensure our readers remain safe. If you operate a healthcare center and are about to bring a medical coder or biller on board, read this guide to steer clear of frauds and scams.

Scam #1 – Upcoding:

By far the most common scam plaguing the healthcare sector is upcoding. To understand what this is let’s consider the example of a patient who visits the local hospital to receive treatment for a sprained wrist.

Once the treatment is completed and the bill is generated, the insurance provider sees that the patient was billed for a broken wrist. Obviously, broken wrists cost more to treat than sprained wrists, but the healthcare provider gets to make more money in the process—fraudulently of course.

It goes without saying that any mismatch between the services offered and the services billed for is a federal offense and can leave your firm facing substantial lawsuits. To give you a ball park figure, the University of Texas Southwestern Medical Center had to pay a compensation of $1.4 million in an upcoding lawsuit back in 2011.

Scam #2 – Unbundling:

Most insurance providers try to save money by offering bundles (i.e. payment plans) for complementary medical services. For example, if you have a minor surgery coming up, then there’s a high chance that local anesthesia will be administered. As a result, the insurance company offers surgery bundles that cover the price of the anesthetic.

Now, a healthcare center could try to bill these services (the surgery and the anesthesia) separately which violates an existing bundle. This (theoretically) entitles clinics to higher reimbursements from insurance providers even though it’s a scam through and through. This deplorable act is called unbundling.

Scam #3 – Phantom Billing:

While upcoding can be written off as a typographical error or a genuine mistake, phantom billing is much more sinister in nature. This scam occurs when healthcare centers charge for medical services that they never performed to ensure that they receive higher reimbursements from their insurance providers.

That being said, it’s worth noting that not all firms that have been caught phantom billing did so out of malicious intent. In fact, there have been countless cases when healthcare center employees have mistakenly copied information from other patients (who actually opted for the services mentioned).

Whether done deliberately or mistakenly, phantom billing is serious a federal crime which can be avoided by opting for the services of a certified medical coder! The Allied Prep Technical Institute offers comprehensive medical billing and coding courses to our students so that they’re better equipped to avoid scams and offer ethical services.

We run a medical training institute that offers students and coding enthusiasts the medical billing and coding certifications – both on campus and online. Our rigorous tests and training programs ensure that our students always have the knowledge and the expertise needed to deal with complicated problems.

Contact us today to learn more about how you stand to benefit from signing up for our classes!

Medical Coding Basics: 5 Things You Need to Know

More and more students are pursuing their majors in medical coding. With public interest in the noble profession at an all-time high, we decided now is the ideal time to give some market information about medical coding.

So, if you’re a medical coding student or if you’re looking to enroll in medical coding classes, here are 5 essential things you need to know.

1. It’s not the same as Medical Billing:

Before we begin, let’s clear out one thing; medical coding and medical billing are NOT the same profession. Given the fact that most promotional brochures tend to use these two terms interchangeably, it’s no wonder that most people mix up the two and consider them to be the same thing.

To set the record straight, medical coding professionals must convert medical records like diagnosis and lab results into alphanumeric codes. Medical billers, however, generate medical bills and bridge the gap between the insurance provider and the healthcare provider.

2. A Brief History:

You may be surprised to know but medical coding isn’t a new profession; it’s been around for centuries. The first medical coding system (called the Bertillon Classification of Causes of Death) was devised by French physician Dr. Jacques Bertillon in the late nineteenth century!

Granted the Bertillon Classification of Causes of Death wasn’t nearly as comprehensive as the coding systems used these days, it’s still widely considered to be the predecessor to medical coding.

3. The Nature of the Job:

Contrary to popular belief, medical coders don’t just have to sit at a desk all day and look at alphanumeric codes; their job is much more complex and nuanced than that. A medical coder’s typical day at work consists of review patient notes and converting them into medical codes.

Factors that dictate the quality of the code include clinical setting (inpatient coding or outpatient coding) and the nature of these services performed.

4. Inpatient and Outpatient Coding:

As discussed above, the complexity of the final bill depends a lot on the clinical setting i.e. whether the client was inpatient or an outpatient. Simply put, this refers to whether the patients had been admitted to the facility and had completed at least a 24 hour stay in the premises.

On the other hand, outpatient coding refers to the medical coding performed for patients who visited the healthcare center but were not admitted.

Fun Fact: If a patient was admitted for a few hours they will not be considered an inpatient unless they’ve been in clinic or hospital for at least 24 hours.

5. Credentials Matter:

It goes without saying that not all medical coders are the same, and as such you shouldn’t expect to have the same paycheck as your peers (more on that later). The most important aspect that dictates your pay grade is the credentials that you boast. For example, do you hold a CPC Certification or a CIRCC certification?

We’ve merely discussed medical coding on the surface as there remains a lot to discuss about the subject. Join us next time as we discuss more important facts about medical coding and list some advantages of doing so that will blow your mind!

About Allied Prep Technical Institute:

We are a medical training institute that conducts medical billing and coding training and provides certifications to our students on campus and online. Our rigorous tests and training programs arm our students with the knowledge and the expertise they need to perform their job at the highest level possible.

Contact us today to learn more about how you stand to benefit from signing up for our classes!

The Perks of Being a Medical Auditor

A medical auditor is a certified professional who reviews a claim that has already been coded and scans for any compliance or coding issues. The purpose of the auditor is to remove any discrepancies so as to ensure smoother processing and minimize payment delays.

While that may sound like a dry subject and a boring profession at first, there are lucrative incentives for those who actually complete their studies. Here’s a closer look at some of the well-known perks of being a medical auditor.

1. It’s a Growing Industry:

The best part of being a medical auditor is the rapidly expanding industry. In fact, numbers posted by the United States Bureau of Labor Statistics show that the healthcare industry looks set to grow by 18% from 2016 to 2026 (due to an aging population). In other words, medical auditors are almost guaranteed jobs in the near future.

2. There’s a High Market Demand:

Speaking of which, all certified medical auditors are in high demand these days. This means there’s a minimum waiting time after you graduate with healthcare clinics even offering incredible contracts to promising students who are yet to clear their CPC exams!

3. You Earn More:

Medical Auditor

While money may not be able to buy you happiness, financial security sure does open a lot of doors. Even in this regard, medical auditors are well off as they’re adequately compensated for their services.

While healthcare technicians earn around $38,040 per annum, medical coders earn an average of $52,000 – with medical auditors earning even more than that!

4. Wide Career Options:

If you hold a medical auditing certification but find the hospital setting to be depressing or if you simply cannot sit in a healthcare clinic anymore, you don’t have to worry about wasting your education as you can choose to become a licensed teacher. This will move you away from the clinic and into the classroom of esteemed universities and medical training institutes.

5. Kick-Start Your Career in Days:

As discussed above, medical auditors rarely sit on the bench as they’re called into action almost instantly as they graduate. Generally speaking, a medical auditing student can expect to have a job proposal waiting for them days after they graduate which is remarkable especially considering the fact that most doctors have to wait for months!

6. Work from Home is a Possibility:

The Perks of Being a Medical Auditor

In recent years, the rise of mobility has seen a lot of industries adopt the work from home approach. This means that instead of wasting away at your office desk, you can choose to work from the comfort of your living room and don’t have to pay extortionate rates on commutes.

7. You Make a Difference:

By far the best thing about being a medical auditor is that you make a substantial difference in the lives of your patients. By scanning and reviewing medical claims, you make sure that they’re error-free and can be processed quickly. This ensures that your patients are reimbursed for healthcare services and that they aren’t financially strained for months!

Because of these reasons (and countless others) we’re strong advocates of medical auditing as a profession. If you want to earn medical billing certifications you can do so by enrolling in our online classes. For years, Allied Prep Technical Institute has been offering impeccable medical billing training classes online that have helped our alumni land respectable and profitable jobs.

Get in touch with us today to learn more about how you stand to benefit from our online classes.


A Few Tips and Tricks for Passing the Dreaded CPC Exam

Are you preparing to sit for the CPC exam?

Well, good luck with your preparations. We hope you do well.

Wait a minute…

In fact, we want you to do well!

Because the more CPC certified professionals we have in our industry, the better.

And God forbid, if we ever visit a hospital for some treatment, we’ll know our claim is in goodhands.

So yeah, we want you to do well for our own sake… (*Wink*, *Wink*)

Passing the CPC exam is not easy.

Well, that’s something we all know. And that’s why we all dread it.

But why look at the obvious from the obvious perspective?

Why not think: I only need to get 105 of my answers correct and I’ll be holding that golden certificate in my hand?

Makes you feel a bit better?

Well, the tips we are going to share next on taking the CPC exam, will make you feel even more better. And also, more confident.

We really want you to do well!

Tip #1: Master your medical terminologies and anatomy

If you know your medical terminologies and anatomy well, you won’t have any problems understanding the questions. This will save you time and time is the only thing that you don’t have in the CPC exam. There are 150 questions to answer and you have 5 hours, 40 minutes only.

Tip #2: Highlight and tab your manuals

The CPC exam is an open book test. The key to passing the test is how fast you can look up codes. Having your manuals highlighted and tabbed beforehand (yes, it’s allowed) can save you a lot of time when you looking up for an answer.

Tip #3: Always start answering from the last question

Questions at the end of the paper are shorter and usually easier. So work backwards when answering the question paper.

Tip #4: Mark the difficult questions and move on

You have roughly 2 minutes 25 seconds to answer each question. If you are finding a question difficult, don’t waste your time on it. Mark it, and move to the next question. Get easier questions out of the way first. This will help you save your time and also help you relax.

Tip #5: Use the process of elimination to answer questions faster

Multiple choice questions (MCQs) are designed to confuse students by providing them with multiple options. But if you proceed smartly, these questions can be quite easy to answer. Experts advise using the process of elimination to answer a MCQ. This strategy focuses on getting the wrong answers out of the way first and then focusing on what’s left for the right answer. It’s a tried and tested strategy in the world of MCQs.

Tip #6: Practice, practice and practice

Last but not the least, practice, practice and practice. The more you practice for the exam, the more chances you have of performing better. Practice CPC mock papers and past papers.

And that’s all about it.

We wish you good luck for your exam!

For further reading: How Allied Prep Can Help You Excel in Your CPC Exam!

5 Known Benefits of Seeking Education Online

In recent years,  has emerged as a popular alternative to conventional colleges (which are notorious for their extortionate fees). As the number of students opting for online college courses continues to increase with every passing year, the general public is finally taking this educational option seriously.

Here are five known benefits of seeking higher education online.

1. Better Mental Health:

It’s a well-known fact that students are more stressed now than in any other time period in human history. Owing to the overwhelming number of projects and assignments that they are assigned, many students often have to put their mental health second to education. This has led to increased levels of depression and anxiety in young adults.

Seeking Education Online

2. A More Diverse Social Circle:

A unique aspect of taking online classes is that it significantly diversifies your social circle. Not only are your course teachers and instructors from different parts of the globe, but your peers may also be from different countries.

This presents a golden opportunity for students to get exposure to foreign cultures which is bound to broaden their horizons.

3. Avoid Commuting:

Nobody likes waking up an hour before class and then sitting in a bus for 45 minutes just to be on time for an 8 AM lecture. Furthermore, long commutes eat up hours of your day and also mentally drain you.

Online classes eliminate the need for a long commute altogether as you can choose to attend lectures from the comfort of your own home. However, if you have guests staying over, you can always grab your laptop, go to the nearest library, and attend a lecture in peace.

4. Unmatched Flexibility:

The best thing about online education is the unmatched flexibility that it provides. Not only do you have a flexible class schedule but you also have the liberty to take your tests and exams when you’re in the right frame of mind.

This presents an ideal opportunity for students who have other (more important) responsibilities such as looking after a loved one, or providing for their family. Many experts believe that this degree of flexibility is why students who opt for online classes are much less stressed than their peers who attend conventional colleges.

5. Self-Discipline:

Unlike conventional schools that force you to go to classes on time and punish you for missing lectures, online classes allow you to choose when you to learn. This means that the student is responsible for their ultimate success or failure.

When faced with these odds, young adults develop a new sense of self-discipline and responsibility. This priceless lesson proves to be invaluable when they apply for a job as potential employers love candidates who are serious about their careers.

We’ve merely scratched the surface of the countless benefits of seeking education online. Join us next time as we discuss in detail the positive impact online courses can have on young adults!

About Allied Prep Technical Institute:

We are a medical training institute that offers medical billing and coding training and certifications to our students on our campuses and online. Our rigorous tests and training programs arm our students with the knowledge and the expertise they need to perform their job at the highest level possible.

Contact us today to learn more about how you stand to benefit from signing up for our classes!


Inpatient Coding Vs. Outpatient Coding: What Aspiring Coders Need to Know

The medical coding practice is divided into two main domains: inpatient coding and outpatient coding.

For an aspiring medical coder, it’s vital to understand the differences between these two coding domains and set a preference from an early stage. This will help them focus their training and education accordingly and spend more time learning about the domain that they are interested in.

So what exactly are inpatient and outpatient coding and how are the two coding domains different from each other?

What is Inpatient Coding?

Inpatient coding is a type of medical coding used for reporting services that are performed on inpatients.

Who are inpatients?

Inpatients are those patients who have been officially admitted to the hospital under a physician’s order.

It must be noted that for a patient to be classified as an inpatient, the patient must spend more than 24 hours at the hospital. Patients admitted to a hospital for 24 hours or less are not classified as inpatients.

Inpatient Coding

During their stay, the patient will be charged for all the services and facilities they use and will be billed accordingly. Since such stays are long, they result in creation of patient records that are quite extensive and intricate. This makes inpatient coding complex and detail intensive.

What is Outpatient Coding?

Outpatient coding is a type of medical coding used for reporting health services availed by outpatients

Who are outpatients?

Outpatients are patients who visit a hospital for treatment but are not admitted. These patients may stay at the hospital for few hours or even overnight.

Outpatient Coding

Since outpatient visits are brief, outpatient coding is relatively less complex than inpatient coding.

What’s the difference in the coding schemes for the two medical coding domains?

Inpatient coding utilizes ICD-10-CM and ICD-10-PCS codes to transcribe the details of a patient’s visit and stay. Outpatient coding on the other hand utilizes ICD-10-CM and HCPCS Level II codes to report health services.

Reimbursements for both types of services are requested under the Medicare program. Inpatient claims are processed under Medicare Part A while outpatient claims are paid under Medicare Part B plan.

In the end, no matter which type of coding domain an aspiring coder may choose to specialize in, they both have their individual importance in the healthcare reimbursement cycle, and both require the same level of commitment and dedication from medical coders.

About Allied Prep Technical Institute:

We are a medical training institute that offers medical billing and coding training and certifications to our students on our campuses and online. Our rigorous tests and training programs arm our students with the knowledge and the expertise they need to perform their job at the highest level possible.

Contact us today to learn more about how you stand to benefit from signing up for our classes

5 Reasons to Rethink College

Since we were kids, we’ve been conditioned by our parents and our teachers to believe that college education is the most telling difference between a successful individual and one who struggles to pay the monthly bills. Continue reading “5 Reasons to Rethink College”

Medical Billing Job: What You Can Expect

Dear Google,

I am preparing for a career in medical billing. I want to know how medical billers spend an average day at work.  What do they do? Who do they interact with? How much workload do they have? Do they have flexible work timings? And any other additional information that you can provide me with to help me better understand of what I can expect when I get into the workforce.

Google is reading your message and writing a reply…

Hello, Aspiring Medical Biller!

An average day in the life of a medical biller is quite exhaustive. You have plenty of claims to create. You have a lot more claims to file. And then, there are some returned rejected claims that you have to review, correct and file again, so that the patient and the doctor can be properly reimbursed.

This can be all too tiring.

But come the end of the day, knowing that you made a difference in the life of yet another patient is definitely satisfying. You get a sense of accomplishment that only medical billers can relate with.

Your job is one of the most satisfying jobs out there and it also pays quite well.

When you will join your first organization, probably the very first question that your employerwill ask youis: what shift timings will you prefer?

A medical billing job offers flexible shift timings. You can choose any schedule you want. Some medical billers are early birds; some love working in the afternoon, while others are happy to work at night.

During their shift, a medical biller is expected to complete and file a fixed number of insurance claims. This number varies from employer to employer. Before leaving for home, you should complete and file the claims assigned to you for the day. Of course, some claims take time to be created, so unless there is a pending deadline, you can take your time.

Medical billers must make sure that the claims they are creating are accurate and free of all errors. For that, a medical biller needs to be in constant communication with doctors, medical coders and the respective insurance companies.

Besides creating, filing and reviewing disputed claims, medical billers may also have other job responsibilities.

Some medical billers deal in full practice management where they handle all aspects of billing for the organization they are working. That is, from submitting claims to tracking accounts payable and receivable to billing patients.

These other responsibilities do not require the understanding of medical coding schemes, but are nevertheless detail intensive.

So, the Aspiring Medical Biller, does this answer all your questions?

Do you have some more questions to ask?

Google recommends consulting the expert team of Allied Prep Technical Institute for any further help.

For now, Google would like to take your leave.

Good luck for your future!

A BONUS read: 9 Qualities that Put You at the Top of the List for Employers After Medical Billing Certification.