Medical Billing and Coding Certifications
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A U.S. Department of Health and Human Services study analyzing Medicare claims from 2020-2021 found $1 billion in coding mistakes. Becoming certified in medical billing and coding can help prevent errors and showcase your expertise to potential employers.
Find out how you can advance your medical billing and coding career by earning a certification. Discover how to get certified and the requirements, including costs and eligibility.
Did You Know…
Annual administrative expenses account for $500 billion to $1 trillion of the nation’s total healthcare expenses.
Source: Health Affairs
How to Become a Medical Biller or Coder
No two companies have the same hiring requirements for medical billers or coders. A high school diploma and work experience may suffice for one position, but another employer may require a certificate or medical billing and coding degree.
To meet the minimum requirements, medical billers and coders usually need an associate degree in medical billing and a certified professional coder (CPC) credential.
Employers may prefer medical billers and coders with practical experience gained from internships and training programs. Particularly, hospitals want formally trained medical billers and coders.
Additional certifications for medical billers and coders can boost your job prospects. The American Academy of Professional Coders (AAPC) offers the certified professional medical auditor, certified risk adjustment coder, certified outpatient coder, and certified inpatient coder credentials.
Differences Between Certifications and Certificates in Medical Billing and Coding
Certifications are an industry credential, and certificates are achieved through a program offered by a university or college. Two- and four-year schools award certificates for completing coursework and exams, while professional organizations, such as the AAPC, provide certifications after you pass an industry exam.
Certifications
- Awarded by a professional organization
- Requires paying for and passing an exam
- Preparation for the exam takes four months in the instructor-led format, or 4-8 months for a self-paced format
- Allows you to work in hospitals and healthcare facilities
- Demonstrates that your skills and expertise meet nationally recognized standards
Certificates
- Takes up to one year to complete
- Graduation depends on maintaining a good GPA
- Credits may transfer toward an associate or bachelor’s degree
- The curriculum is unique to the university or college
- Programs may provide opportunities to complete an internship
Questions About Medical Billing and Coding
Medical billers and coders process patient medical claims for reimbursement. They perform different functions collaboratively to ensure that the healthcare providers get payments and insurance coverage claims.
The job requires checking medical records for coding or billing errors and creating a billing statement for the insurance company or patient. Medical billers sometimes need to contact healthcare providers for more documentation or to verify a patient’s insurance coverage. All the while, medical billers and coders must adhere to HIPAA regulations.
Governing Bodies That Grant Certification
The American Academy of Professional Coders (AAPC), the American Health Information Management Association (AHIMA), and the Practice Management Institute (PMI) award professional certifications to workers with medical billing and coding certificates. Certification programs also accept learners with no academic background in billing or coding.
AAPC
The AAPC offers many medical billing and coding certifications. Options include the certified professional biller (CPB), certified professional coder (CPC), and a dual-certification program to earn CPB and CPC certification simultaneously. Many employers do not consider applicants without a CPB or a CPC. Some students earn a certification in just eight months with an AAPC exam preparation course. According to the AAPC, 80% of learners pass the certification exam on the first try.
Students can complete certification classes fully online at their own pace. Career advisors help students find a job that matches their skills.
AHIMA
AHIMA’s certifications appeal to new and experienced medical billers and coders. They offer two certifications: the certified coding associate (CCA) for beginner medical coders and the certified coding specialist (CCS) for experienced medical coders. Classes cover topics, such as medical coding and health information management. Some classes award a micro-credential and cost less than certification classes. Learners can work at their own pace during some classes. AHIMA members receive tuition and exam discounts.
Students can transfer microcredentials from AHIMA to a college degree or certificate program. AHIMA partners with Purdue University Global, Pierpont Community and Technical College, Southern New Hampshire University, and the University of Saint Mary.
PMI
The PMI offers five training programs and certifications for new and seasoned medical office professionals. Credentials include the certified medical coder, certified medical insurance specialist, certified medical office manager, certified medical compliance officer, and certified medical chart auditor.
The certified medical coder course prepares experienced medical coders who have one year of work experience. It prepares them to pass the CMC exam through courses in medical terminology, ICD-10-CM coding, procedural coding, and advanced coding. The program offers 24 continuing education units for $1,375. Available formats include live online courses, online training, and in-person classrooms.
Medical Billing and Coding Certifications
Learners can explore several medical billing and coding certifications. Each certification helps workers learn new skills and grow their careers.
Certified Coding Associate
AHIMA’s certified coding associate (CCA) costs $299 for nonmembers and $199 for members. This certification appeals to workers with at least six months of experience. Candidates must complete a minimum of one AHIMA program and outside coursework. The two-hour computer test comprises 105 questions, including 15 pre-test questions and 90 scored questions. Test-takers need a minimum 300 score to pass. This top industry certification shows professional competencies and commitment to the field.
Certified Coding Specialist
The certified coding specialist (CCS) costs $399 for AHIMA nonmembers and $299 for members. Candidates need two years of work experience, or CCA certification, plus one year of experience. Other requirements include completion of anatomy, medical terminology, and coding courses. The test contains 107 questions.
Certified Coding Specialist — Physician-Based
CCAs with at least two years of experience can pursue the certified coding specialist — physician-based (CCS-P). The CCS and CCS-P use the same eligibility requirements and pricing. They differ in that the CCS-P exam focuses on healthcare business operations. Many of the 97-121 exam questions focus on diagnostic coding, research, and procedure coding.
Certified Inpatient Coder
Certified inpatient coders (CIC) work at hospitals processing new patients’ personal and medical data. They work in four coding systems, including ICD-10-CM and ICD-10-PCS. The exam includes multiple-choice and fill-in-the-blank questions. Workers renew their certification by earning 40 continuing education units (CEUs) every two years.
Certified Outpatient Coder
AAPC’s certified outpatient coder (COC) appeals to workers in many healthcare settings, such as hospitals, clinics, and dialysis centers. The exam costs $399 and includes 100 multiple-choice questions. The test covers medical terminology, coding guidelines, and compliance. COCs must earn 40 hours of CEUs to renew their certification.
Certified Professional Coder Apprentice
To earn a certified professional coder apprentice (CPC-A) designation, you must pass the exam, which only AAPC members can schedule. The CPC exam asks 100 multiple-choice questions, and you must get at least 70% correct to pass. You have up to four hours to complete the exam, which tests your proficiency in accurately using ICD-10-CM, CPT, HCPCS Level II codes. The exam costs $399. This fee includes one chance to retake the exam.
Certified Professional Coder
After passing the certified professional coder exam, you get a CPC-A designation, which is an apprenticeship status. After completing two years of coding experience, the apprenticeship status is no longer necessary, and the designation becomes CPC.
To advance to a CPC, you must submit two letters of recommendation, including one from a previous employer. You can get one year of work experience for a completed CPC-A Practicode online program and 80 contact hours for a coding course.
Certified Risk Adjustment Coder
If you have experience in anatomy, medical terminology, anatomy, pathophysiology, and ICD-10-CM diagnosis codes, you can specialize as a certified risk adjustment coder (CRC) to develop risk scores for patients. The exam costs $399. You’ll get up to four hours to answer 100 multiple-choice questions either online or in person. According to AAPC, 80% of students pass the exam on the first try. Exam preparation courses start at $1,499.
Specialty Certifications in Medical Billing and Coding
Specialty certifications in medical billing and coding let workers specialize in a healthcare subfield, such as anesthesia or cardiology. These certifications appeal to experienced professionals.
Certified Ambulatory Surgery Care Coder
The certified ambulatory surgery care coder (CASCC) attracts candidates working in ambulatory surgery care. The 100-question certification exam covers different surgeries and reimbursement rules. Test-takers pay $299 for one attempt or $399 for two. To renew this certification, candidates must complete 36 CEUs, and eight of them must be specific to ambulatory surgery care.
Certified Anesthesia and Pain Management Coder
The certified anesthesia and pain management coder (CANPC) exam assesses knowledge of appropriate codes and Medicare billing regulations. AAPC recommends but does not require two years of experience. Test-takers pay the same exam fee as those earning the CASCC. They can schedule the exam at least four weeks in advance and need a minimum score of 70% to pass.
Certified Cardiology Coder
Certified cardiology coders (CCCs) specialize in coding and medical terminology related to heart medicine. The 100-question, four-hour exam covers cardiology basics and related surgical procedures. Test-takers can buy AAPC study guides to prepare for the exam. Professionals review exam results on their My AAPC account.
Certified Cardiovascular and Thoracic Surgery Coder
Certified cardiovascular and thoracic surgery coders (CCVTCs) use many of the same skills as CCCs. However, CCVTCs further specialize in thoracic conditions and treatments. AAPC recommends that CCCs pursue the CCVTC after gaining professional experience. Test-takers may use approved reference materials during the exam.
Certified Documentation Integrity Practitioner
Healthcare providers hire certified documentation integrity practitioners (CDIPs) to develop and maintain accurate patient records. Eligibility requirements include holding an associate degree or at least one AHIMA certification. Candidates also need two years of work experience. AHIMA members pay a $259 exam fee. The computerized test contains 106 scored questions and 34 pre-test questions on clinical coding practice and leadership.
Certified Emergency Department Coder
Healthcare centers with emergency rooms hire certified emergency department coders (CEDCs). These coders specialize in codes for emergency procedures, such as fracture care. The 100-question test takes four hours to complete. Test-takers can use approved references during the test.
Certified Evaluation and Management Coder
The certified evaluation and management coder (CEMC) certification appeals to AAPC members with experience in evaluation and management coding. Test-takers may use one reference during the 100-question multiple-choice exam. Test questions cover decision-making coding and time-based coding.
Certified Family Practice Coder
Coders working in a family practice healthcare setting can earn the certified family practice coder (CFPC) certification. The test focuses on Medicare billing fundamentals, including consultations and shared visits. Other questions assess medical terminology and time-based coding skills. The exam costs $299 for the first attempt. Test-takers must pay $399 for two attempts.
10 Skill Sets from a Medical Billing and Coding Certification
Students who pursue medical billing and coding certification develop many in-demand skills. They can continue improving these skills as they gain work experience.
- 1
Knowledge of Medical Terminology
Coders and billers must know common medical terms relating to body systems, injury, and disease. This knowledge helps them match terms in medical records with the right software codes. Knowledge of medical terminology also helps them communicate with patients, peers, and healthcare professionals. Many programs require a medical terminology class in the first term.
- 2
Computer Literacy
Medical coders and billers spend much of their day on computers. They must keep up with industry software and the latest best practices. Computer skills help workers troubleshoot problems and recognize incomplete data. Students learn these skills in coding basics classes.
- 3
Bookkeeping
Similar to bookkeepers, billers and coders help organize and manage a healthcare office’s finances and ensure their financial records are accurate. Mastering bookkeeping skills involves paying close attention to facts and figures. Learning bookkeeping software can aid billers and coders in verifying billing accuracy.
- 4
Accuracy
Mistakes in medical billing or coding may lead to treatment delays or incorrect patient charges. Workers can maintain accuracy by double-checking their work and not rushing through required tasks. Certificate- and degree-seekers learn other accuracy best practices while performing coding and billing exercises.
- 5
Strong Communication Skills
Medical billers and coders need strong communication skills. These skills allow them to help patients and collaborate with healthcare professionals. Answering questions, resolving issues, and completing tasks all involve communication. Effective communication also reduces mistakes, as workers can ask for help when necessary.
- 6
Teamwork
Advanced communication and interpersonal skills make medical billers and coders effective team members. They use these skills to collaborate with peers, patients, and healthcare providers. Teamwork leads to positive outcomes, including accurate patient records and billing statements. Top medical billing and coding certifications promote teamwork skills through group projects.
- 7
Adaptability
Medical billers and coders should be able to adapt quickly to changes. These changes may include sudden problems, increased workloads, or longer hours. Medical billers and coders with this flexibility do not make careless mistakes under stress. They can also apply this skill in other professions.
- 8
Reading
Medical coders input medical reports into databases. Performing this task well requires them to read documents closely. Medical billing and coding degrees train learners in these skills with classes in coding, healthcare, and insurance.
- 9
Attention to Detail
Detail-oriented workers typically make fewer mistakes, allowing better patient outcomes and correct billing statements. Medical billing and coding classes offer learners specialized feedback. This helps professionals become more attentive workers. Professionals can further develop this skill by double-checking their work.
- 10
Strong Organization Skills
Many medical billers and coders work from home. This setting requires strong organizational skills. Professionals should create a dedicated workspace and create a digital filing system to keep documents organized.
Page last reviewed on June 17, 2024
