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Ah, the question for a generation of back-office anal-retentive types with a technomedical bent and at least a high school diploma or GED (maybe an MFA and a part-time studio), or an empty nest, or Veterans' benefits and a vague idea of what to use them on instead of 4 years of college.If you had asked me this question even 10 years ago, I would have been much more in favor of recommending medical transcription. However, now that we have the mandatory Electronic Health Record being completed in doctors’ offices by any number of staff who may have little or no transcription or clerical background, and who may actually be health caregivers (like nurse's aides who take your vitals and then must start typing, and who have been drafted into the position of noting what the patient says before the doctor sees them), I would have to say that from a job longevity point of view, medical billing and coding is likely the wiser option in which to specialize.Many seasoned hospital medical transcriptionists (MTs) were displaced by the advent of the EHR. Some managed to become EHR “scribes”, while others faded into various secretarial jobs and left their medical specialization to the four winds. Then too, many MTs took insurance and math refreshers and crash courses and moved into billing/coding and charge data entry. And many others just took the whole curriculum along with the first-timers, despite significant redundancy.It has often been said that former medical transcriptionists make the best billers and coders because they understand what the procedures, studies and interventions mean in the context of the particular patient's healthcare situation, because they used to type it.Both jobs require the ability to see all the little pictures that make up the big picture. There are certain inalienable, un-fake-able skills, and then there is the need to be able to assemble puzzles in which pieces are missing.Facts: People will always pay good money for someone who can get them more money. People will also always value highly those people who can catch their errors and keep them out of trouble. And finally, people will always gladly pay other people who make them look good. Perhaps the first situation results in priority being given to a gifted Superbiller over an MT (medical transcriptionist), creator of error-free medical documents that meet HIPAA and JCAHO specs. In many ways a lot of your marketability depends on the value placed on it by the doctor, hospital or agency who hires you, or doesn't.However, as with any career, to succeed and be happy, you need to take into consideration your own personal interests, skills and preferences: for example, whether you like working with composition and grammar, are willing to research discrepant vocabulary and have an ear for accents, versus whether you like working with schedules and figures, have a good mind for business math, can make order out of chaos and can follow complicated decision trees.Are you more like a technical writer or an accountant? More of a librarian or a paralegal? Neither of these jobs is the same as a medical transcriptionist versus a medical billing and coding specialist, but they each draw on certain personal proclivities or talents, respectively.In either position you are going to have to have a strong background in the language of medicine — not just how to spell it but what it means, why things are combined that way, and how various partial forms fit together to give you clues as to the final answer — because you must not forget that there are real people at the end of the paper trail.As well, you must keep up to date with industry and governmental standards and regulations to do a professional job. Your work can end up in Court and can help speak for a patient who is in the grave.You are always going to have to be a ready reference book-flipper, ready to take down the right 10-pound reference book or use the right search software whenever you have a suspicion of a question, because you can't just guess and yet you can't leave blanks, and yet, you have to work fast.You have to be detail-oriented, and you are going to have to be able to put up with finding other people's mistakes and correcting or flagging them without getting resentful, because the ultimate goals are that the patient receive the proper care and that the physician receive the proper protection and compensation. Otherwise you are out.You will want to look into how long your formal training will take and how much practicum or supervision as a rookie/ ”newbie” you will have to undergo before you can start making any livable money. And once you complete school, what is the job market going to be like?Talk to people who have been doing the work that interests you for awhile and see how long it took them before they started making the money that they needed to live on, because there is quite a learning curve for both jobs and you will not make good money right away. You need to build speed, accuracy, intuition and confidence. Survey the industry for each job and see who is hiring, what kind of reputation and retention they have, and under what circumstances they give raises, if ever, or if you just have to create your own raise by getting faster and faster at cranking it out.Would you be a person who wanted to work at home or a person happiest in an office? Both fields can offer both settings. Both take a lot of discipline. At home you will be essentially unsupervised, plus/minus phone calls or emails, but conversely you may have fewer distractions and greater productivity.Will working in your home environment help you or hurt you?Note, here I must debunk an odiously deceptive, famous magazine advertisement for an MT program which shows a glowing woman dressed in a demure business suit (I've never seen a working MT or a biller/coder in a business suit anywhere), typing blissfully at home with a baby balanced on her lap and a drooling toddler wrapped around her leg (one of which feet should have been planted on the transcriber foot pedal) and with no earphones playing back dictation for her to transcribe. It looks like the easiest job in the world to do from home.OK. (A) You can't transcribe with your arms around a baby. You can't even reach the keyboard. (B) You can't hear the dictation in your earphones around the screams of a teething toddler. (C) Good luck keeping your painstakingly sorted invoices in chronological order around two grabby little kids who are equally capable of deleting a whole morning's work. (D) True, if you work graveyard shift at home, and you do manage to wake up at 11:00pm, no one knows or cares if you're in your nightgown, but odds are the baby will spit up on it or otherwise pull you away from the STAT Trauma Alert H&P's that the doctor is waiting for you to finish so he can go home. (E) You have to pay nominal attention to the work, or at least wear earphones, and at least look at it. You just do. (F) That mythical Jackie Kennedy-era business suit bears repeating. I always transcribed barefoot, and I am not the only one nor do I imagine billets and coders are much different. Your legs may swell at the 10-hour mark.In both jobs, your hands, eyes, legs and back will take a beating and you will find that such sedentary work comes with its own kind of wear and tear. You can't do it forever. Right about the time you're getting good, fast and accurate (profitable), you start needing breaks, which bring things to a halt. Thus would you begin looking for potential advancement into a managerial, training or supervisory role still using your expertise, or would you rather just get better and faster at your job, create boilerplate routines and templates, and keep your head down in your original position, producing specialized sets of documents and making hay while the sun shines, until you burn out?Consider whether you would want to be paid by the week, the hour, something like draw-against-commission, or piecework-production such as by the line of text or the chart or the bundle of charge data tickets coded and input? When you work at home and are not on production, there is an element of the honor system implied. You can't make any money if you go get coffee after each report.Medical transcription has gone through several waves, each time changing with evolving technology and now with legislative and insurance requirements.When I first transcribed, we used looped magnetic belts for dictation, 5 sets of carbons with matching white-out colors, and electric (but not Selectric) typewriters. The last time I transcribed, I was correcting voice recognition documents generated for heavily accented dictators in oncology…lots of chemicals…filling in blanks and sending feedback. Each document was handled by at least four “re-listeners” before it was finished.Similarly, medical billing and coding have left pegboard and ICD-9-CM behind in an effort to keep pace with technological and pharmaceutical advances, software systems, automated diagnostic schedules, which have all become obsolete while I was writing this answer.This “evolution” will continue to happen as long as government agencies and private payors are involved in health care regulation. Don't blink — you might miss the newest generation.In many ways career choice is a tossup. No one can foretell the future. You can only search yourself and try and find the best fit. In my opinion, experience with medical transcription and with medical billing/coding should be recognized as having overlap, just as accounts receivable overlaps payables, or human resources overlaps payroll and benefits. Everybody doesn't have to share the same room, but they should be on the same floor, in my opinion. And the people in these rooms have to possess the focus and willpower to sit in their chairs and work, with or without visible supervision.My best practical suggestion in terms of career choice is that you talk to some people who are doing the job(s) that interest you now. Either way, you're going to need your medical core curriculum and to know your way around the software (although some is proprietary, so you have to be a versatile quick study). Next you can decide whether you lean more toward language or toward math. People with on-the-job experience can tell you what the schools and employers won't say about real-life work in those capacities. They will tell you how reliable the employers are, the tricks that they pull (and there are a few), who gets the lucrative accounts and how, whether there is plenty of work, the little aggravations that can add up to the one big one, and what you can do to get national accreditation, which will help you make more money for the same or more challenging/regulated work product.The final question, whether to work at home or in an office, really should be the final question, after you have answered everything else.A few considerations when working at home regardless of which career you take:What will you have to invest to get your home work space ready for efficient work? Will it be dedicated and secure space, inaccessible to the family? How will you insure it (with insurance) and ensure the safety and confidentiality of your work? What will having the home office do to your taxes, both property and income? Will you be an employee or an independent contractor? Do you need an occupational license? Is your zoning affected? Is your work safe from the explorations of your pets? How will you receive and return your work?How much of your work day will be unpaid? Will you be printing, proofing, figuring charges, invoicing clients, keeping your own payroll records, making free corrections and reprints, archiving? Will you be expected/allowed to talk to the client and solve problems, and will they be calling you at home for favors? What if you're on graveyard and they call you in the afternoons when you're trying to sleep? What happens if you have an equipment malfunction, a personnel question, a virus, a hurricane and a power outage?What if there is a work shortage and those without seniority are told to log off? What if this happens every day, halfway into the shift, and cuts your paycheck in two? What if you have to spend an hour in the car, unpaid, each day, scrounging for somebody else's overflow?How permanent is your schedule? How often will you have to change accounts — just when you have finally gotten a system organized which allows you to make some money on it? Will you get the same pay, be allowed to abide by the same personnel policies and benefits, and be evaluated in the same way as your non-office-based counterparts? Will you be kept in the loop about matters that are shared routinely with in-office staff, so that you feel like a member of the company? Or are you going to be the uncounted “red-headed stepchild,” out of sight and out of mind?These are to name just a few. Weigh them against the lack of a rush hour commute and working in your fuzzy slippers.To advance yourself essentially while working in isolation, and to see other human beings sometimes, it helps to see if there is a branch of a professional association nearby where you can network and find out about continuing medical education, conferences, testing, shadowing, help desk, and other experiences of MT/billing/coding culture that you would want to have if you decided to be certified. (Please don't forget to factor in the costs of both education and ongoing educational materials.)Note, it is the kiss of death to approach a company with your decent keyboarding speed but no medical terminology background, just the confidence that you will “pick it up.” This is belittling to everyone who jumped through the expensive hoops at community college and studied and paid their dues. It suggests you will be a guesser, which is a liability. Occasionally a small office will take you on — for no pay — calling you a “proofreader.” But this is risky for them given confidentiality and financial laws.These two fields are both constantly changing, and the reference materials change right along with them. You should expect to be spending money all the time to build and maintain a library of current references. There are also dues to professional organizations, and they are steep but worth it in order to network and to stay competitive/marketable.All that having been said, I would encourage you to pursue both fields with an open mind as you are mastering the medical curriculum, and, with an awareness of yourself and your personality, to be thinking about where you are going to end up. If you can, undergo vocational aptitude testing and/or talk to some technical training advisors, or even find a mentor with years of experience in the job that instinctively appeals to you the most. If you know someone who is working but still has their textbooks, look them over and see if they put you to sleep or fascinate you.It used to be that you had to be able to type uber-fast and uber-accurately, or be hell on wheels at the 10-key and adding machine (yes, we called it that), and have a big red medical dictionary or a diagnostic coding manual or know where you could lay hands on one. Nowadays every 8-year-old with a computer can enter data as if they were attached to the cursor at their fingertips.. Working at home adds the handicap of facelessness. To have a future, you have to distinguish yourself in all aspects of the job. And even though you work at home in your jammies in the middle of the night, and even if you have a supervisor who knows you and your performance, you will Occasionally have to manage to get along with similarly clad co-workers. Some at-home staff really like the isolation, but others have a hard time reconciling the social aspect of the job; and some employers prohibit home workers from talking to each other, supposedly in the interest of productivity.You always have to make an absolute commitment to preserving patient/ physician confidentiality, and nowhere is this more apparent than when you work from home. Patients' experiences and doctor's reactions or offhand comments can sometimes be shocking and seem just to beg to be shared. Sometimes it's shockingly upsetting, sometimes it's funny, and sometimes it's just too weird not to repeat. But chatterboxes who think this would present too great a temptation should just walk away now. The rule is to type, bill it or code it, and then forget you ever saw it.. If a copy of the finished work needs to be saved for teaching or reference purposes, because you know that otherwise the same hellishly confounding questions will come up again, and next time, it shouldn't take two hours to finish, then all identifying data must be redacted so that it is a blank template. Again, this is especially important when it comes to the curious eyes of other household members when you work at home.l.Both jobs, MT and billing/coding, are nerve-wracking, back-breaking, tooth- grinding, eye-squinting, sometimes mind-numbing work, with all manner of characters and personalities drawn to it, from frustrated doctor-wannabes to shortcut-taking clerical types whose eyes are on the paycheck. You receive minimal recognition, if any. In a lot of people's eyes, you are so much office equipment. You have to balance taking quiet pride in your skills against knowing your (low) place on the totem pole. That is just a reality that must be considered.However, both jobs are also still extremely gratifying when you know you are giving exacting professional people and trusting patients what they need because you do your job right.Whichever job you choose, and wherever you choose to do it, you can make a decent, secure-(ish), honorable living at it if you keep your fingers moving, your eyes on the prize, and your personal standards high. Good luck.