Independent Nurse Billing and Coding?

[Nicole Spencer, BSN, RN]

Hi Guys!

I wanted to know how can I learn the basics of billing/coding so that I can submit claims to Medicare/Medicaid/Private insurance companies for work that I do independently? I do not want to earn a degree in billing/coding, but I do need to learn how to submit claims quickly and accurately. I am starting from the ground up so please speak in layman's terms in your reply. I have no previous knowledge.

Thank you!

[NRSKarenRN, BSN, RN]

Unless you are an Advanced Practice Nurse, you can not independently bill Medicare; independent billing to Medicaid is state specific if permitted. I'm assuming you are working in outpatient setting.

Check out your local community college to see if they have health professions education, some provide coding training:

https://www.dccc.edu/academics/programs/certificates/medical-coding-and-billing-certificate

There are numerous online coding cources you can choose: need education in CPT (procedures) and ICD10 (diagnosis).

An option is to contact a coding company to help you set up a super bill (form to list services provided with billing codes listed that you could check off ) to use for billing ----along with nursing/medical documentation to support chosen codes.

Have you signed up to obtain an NPI number?

The National Provider Identifier is a 10-digit numeric identifier that must be used on claim forms submitted to payors by individual and organization health care providers who meet the definition of a "covered entity" under the Health Insurance Portability and Accountability Act (HIPAA), beginning May 23, 2008.

Additionally, you will need to become a provider with each insurance company in order to bill insurance---can take 3-6 months to become approved provider. Again, an outside company can help you with this important task.

Midlevel U has several articles about coding that may be helpful to you including: 5 Resources for Billing and Coding Ignorant Nurse Practitioners

Best wishes in your journey.