Medical Billing and Coding Demystified: A Self-Teaching Guide

By Marilyn Burgos, Donya Johnson and Jim Keogh
Reviewed By Katherine Kay

(McGraw Hill Books - ISBN: 978-0-07147220-3))


This book covers the basics of medical billing and coding for the person who wants a job in a medical practice or hospital. It’s an informative book that covers the fundamentals of billing, insurance, and the health industry.

A medical billing specialist is someone who ensures the doctor gets paid. This person handles the paper work and forms that are submitted electronically to the insurance companies. There are detailed rules, policies and regulations set by insurance companies, and government programs like Medicare and Medicaid for submission of these forms.

Medical Billing and Coding Demystified covers the history of insurance and medical economics, legalities, the importance of confidentiality of medical records, contracts and ethics. One chapter gives a mini-crash course on medical terminology and how to decipher medical words by understanding the suffixes, prefixes and roots of words.

The dynamics of a medical office are explained with an introduction to the medical staff, office procedures, and telephone etiquette. An explanation of various diagnostic procedures and how these procedures are coded using reference books like the International Classification of Diseases Clinical Modification, ICD-9, is explained.

Insurance claims, which medical billing specialists submit for reimbursements to pay doctors, are covered. Coding using Current Procedural Terminology (CPT) manuals are also discussed.

Insurance plans from managed care to indemnity are explained— PPOs, POSs, HMOs, auto insurance for health, disability, workers’ compensation and liability. The book touches on all the details, regulations, and various agencies involved in health insurance and government insurance like Medicare and Medicaid.

The loss of time and the cost of errors on claims forms submitted to insurers are discussed in the book. The authors also discuss the economics of premiums and interest and even how insurers will delay reimbursements to doctors, thereby accruing more interest on the premiums collected from patients.

And, of course, ethics is an important part of the health industry. Just recently two doctors were arrested for fraud because they were billing insurers for claiming to see patients they never saw.

The book also mentions procedures of handling claim disputes and the appeal process. There’s a chapter about medical billing software; and the last chapter is about finding a job, writing resumes, cover letters, the job interview, potential job positions, and alternative career opportunities like consulting, writing or teaching.

The book contains big type and is a very easy reading experience for the reader. The book gives a general overview of the field and does not go into great detail in any area. Each chapter finishes up with a summary and a quiz of 10 questions. There is a 100- question final exam at the end of the book. For those young, inexperienced job seekers, the authors discuss in the last chapter how to prepare for interviews, answer the phone and other elementary instructions.

The book is published by McGraw-Hill and is part of a popular series of books from the Demystified Series.

Entrepreneurs and known professionals in the field have written better books on the subject. Start Your Own Medical Claims Billing Service by Rob and Terry Adams and Entrepreneur magazine are a good read offering detailed facts and good medical claims billing resources, especially written for the entrepreneur and home-based business.

Medical Billing and Coding Demystified sells itself on the cover by promising an “enlightening way to learn” and a way to “find out what it takes to succeed.” It does not make a return on its promises, however. There are a few good sections about healthcare economics, the claims process, coding, and even the resume tips are market savvy.

But the problems of the book outweigh the positives. The book is replete with typos, not just one or two, but many. Sentences do not flow well. It’s as if three writers wrote without a final smoothing over. Shortcuts are taken in the book by repeating sentences, entire paragraphs, and quick paraphrases.

The book needs a good editor to give it a thorough cleaning up. I would not recommend this book to anyone because it’s too sloppy, does not deliver on its promises, and because you can find better material elsewhere. The book pretends to be the answer to coding and billing, but it barely scratches the surface and does not give comprehensive tips or resources about where to find real facts and training.