Medical billing and coding professionals can verify their knowledge, skills and experience by obtaining professional certifications. These credentials are offered by two main governing bodies and can be earned by taking exams. Some certifications also require specific work or educational experience. Read on to learn more about medical billing and coding certifications, their benefits and how to earn them.
The Importance of Certification
While it is possible to pursue careers in medical billing and coding without professional certifications, certification shows that a person has been properly trained and has the knowledge and skills needed to be a proficient medical coder or biller. Here are some top reasons to get certified:
Although the medical coding and billing field is growing faster than average with a 15 percent project growth by 2024, it is a competitive market. Most employers look for professionals who have at least one certification or who can get certified shortly after hire. (Job outlook) (How to become)
Opportunities for advancement
Becoming certified, especially in multiple coding specialties, allows professionals to move into new job positions more easily and shows employers a dedication to continuing education and the field as a whole. This display of dedication pays off. In fact, in 2015, AAPC members with two or more certifications earned 24.5 percent more than those with one certification. Members with three or more certifications earned nearly 40 percent more than those with only one. (Align your credentials) (Credentials tip the scale)
While becoming a member of certification-granting organizations is not always necessary to become certified, membership does open up connections to other medical coding and billing professionals. Connecting with individuals and groups who understand and value professional certifications and education can lead to a variety of opportunities. (Networking)
The benefits that come with passing a certification exam are not just for potential employers. Certified individuals can feel confident in the accuracy of their work, and training for certifications can lead to new knowledge and growth as a professional. (Why certify)
Governing Bodies That Grant Certification
Two main bodies grant certifications in medical billing and coding: the American Academy of Professional Coders (AAPC) and the American Health Information Management Association (AHIMA). Both organizations offer credentials that showcase specific skill sets, so it is important for professionals to understand the certifications offered by each when choosing certification exams.
Originally founded with the goal of raising outpatient medical coding standards, AAPC has since expanded its training and certification to cover all aspects of the business side of health care. Certifications are offered in medical billing, medical coding, auditing, medical documentation, compliance and practice management. An annual membership costs $150, but students with proof of active student status can get a membership for $80 per year. Qualifying students are enrolled in at least one field-related course and have not yet received any AAPC certifications. Certification exam costs vary, but most tend to be around $300-$400 with one opportunity to retake each exam. AAPC also offers continuing education units, which are required to maintain certification and ensure professionals stay up to date in the field. Webinars, workshops, courses, conferences and local chapters all provide continuing education to AAPC members.
Focused on certifications for those who practice health information and informatics, AHIMA-granted credentials tend to be geared less toward business elements and more toward the effective and efficient management of health care records in various settings. A standard membership costs $175 per year, but memberships are available at reduced prices for students ($45 per year), recent graduates ($100 per year) and members 65 years and older ($60 per year). Members can take certification exams at discounted rates. Core exams cost $399 for non-members and $299 for members, and specialty exams cost $329 for non-members and $259 for members. Along with two certifications specific to health information, AHIMA offers three coding and four specialty certifications. Continuing education quizzes, online education, virtual labs and in-person courses allow medical billing and coding professionals to maintain certification and stay current in the field.
Medical Billing Certifications
Certification in medical billing shows a professional’s ability to effectively navigate all aspects of billing and revenue without compromising reimbursement. One primary certification exists for professional medical billers: the Certified Professional Biller (CPB).
Certified Professional Biller (CPB)
The Certified Professional Biller credential signifies that coders can handle the many elements of the medical billing and reimbursement cycle, including preauthorization, submitting appeals in case of denial, posting payments and following up to collect outstanding fees. Through their broad skill set, certified individuals can contribute to the smooth running and financial well-being of medical practices and facilities.
The CPB examination covers insurance requirements as well as the differences between private insurance and public health plans, including managed care and worker’s compensation. Candidates should be aware not only of coding practices, but also of the guidelines for local or national coverage as well as government regulations affecting health care and debt collection.
Certification requirements: AAPC requires current membership for CPB certification and recommends that candidates hold an associate’s degree. Those applying for CPB credentials should prepare for the numerous elements of the examination, paying specific attention to laws like the Health Insurance Portability and Accountability Act (HIPAA) and the False Claims Act.
Approved manuals: Candidates may refer to certain approved manuals for the CPB examination, such as the American Medical Association (AMA) editions of Current Procedural Terminology (CPT) procedural coding guidelines. Examinees can choose their preferred edition of guidelines for International Classification of Diseases (ICD) and Health care Common Procedure Coding System (HCPCS) Level II codes. All manuals must be for the current calendar year, and prospective test-takers should refer to rules against the use of electronic devices and unapproved resource materials.
CPB exam information: Examinees can expect a proctored examination that allows five hours and 40 minutes to answer 200 multiple-choice questions. Topics cover varying health plans, billing regulations, claim forms and insurance payment policies. The test explores the use of coding resources, compliance with privacy laws and requirements for medical record retention. Questions on reimbursement, collections, appeals, denials, accounts receivable, electronic claim submission and other subjects also appear in this broad-ranging exam.
Medical Coding Certifications
Certifications verify an individual’s knowledge of the codes that identify medical services, procedures and supplies for purposes of billing and reimbursement. Certified coders can apply coding guidelines correctly by using resources like the CPT, ICD and HCPCS. Code sets undergo regular updates, so continuing education and training programs can help professionals maintain their certified status as coding systems evolve.
The Certified Coding Associate credential is awarded to coding associates who can competently code in any setting, including both physician practices and hospitals.
The Certified Coding Specialist credential verifies a coder’s ability to classify inpatient and outpatient medical data in a hospital setting.
The Certified Coding Specialist–Physician-based credential is geared toward professionals who specialize in coding in physician-based settings. Individuals with this certification show mastery-level coding skills used in physician offices, group practices and specialty or multi-specialty clinics.
The Certified Inpatient Coder credential specifically addresses inpatient hospital and facility coding. This certification verifies a professional’s ability to understand medical records and create accurate inpatient code from those records and verifies an understanding of outpatient reimbursement methodologies.
The Certified Outpatient Coding credential targets the use of codes in hospitals and facilities, such as ambulatory surgical centers. The COC attests to a professional’s skills in coding emergency department visits, same-day surgeries, diagnostic testing and other services, such as physical or speech therapy.
Certified Professional Coder
The Certified Professional Coder-Payer credential concerns coding for organizations that process medical claims for payment. This certification addresses skills for handling claims submitted to private or public health plans like Medicare or Medicaid. The CPC-P exam hones in on adjudicating claims from the payer’s viewpoint, highlighting the differences between processes for insurance companies and those for health care provider offices and facilities.
The Certified Risk Adjustment Coder certification is awarded to those who demonstrate proficiency in reading medical charts and assigning appropriate diagnosis codes used in risk adjustment models. CRCs also show an understanding of reimbursement, compliance and audit processes.
Specialty Certifications in Medical Billing & Coding
Specialty credentials confirm the expertise of experienced coders in specific medical disciplines ranging from cardiology to anesthesia. These certifications focus on specialized procedures and regulations, including Medicare billing guidelines and the codes commonly used for a variety of disciplines.
CASCC: The Certified ASC Coder credential relates to billing for Ambulatory Surgery Centers (ASCs), including the interpretation of operative notes and an overview of the types of surgery performed at ASCs.
CANPC: The Certified Anesthesia and Pain Management Coder credential pertains to coding for surgical cases, codes from the American Society of Anesthesiologists (ASA), and elements of anesthesia claims, such as units of time.
CCC: The Certified Cardiology Coder credential verifies professional experience with coding for surgical procedures performed by cardiologists, such as heart catheterization and coronary interventions.
CCVTC: The Certified Cardiovascular and Thoracic Surgery Coder credential shows a professional’s familiarity with codes for cardiovascular and thoracic surgeries, such as cardiopulmonary bypass operations.
CCPC: The Certified Chiropractic Professional Coder credential affirms a person’s ability to code radiologic, neurologic and musculoskeletal diagnostic procedures.
CDIP: The Certified Documentation Improvement Practitioner credential is awarded to those who show competency in clinical documentation as electronic health records change documentation processes.
CEDC: The Certified Emergency Department Coder credential verifies skills in coding for typical emergency services, such as laceration repair, fracture care, removal of foreign bodies and moderate sedation.
CEMC: A Certified Evaluation and Management Coder credential confirms professional experience with Medical Decision Making (MDM) guidelines used in multiple specialties, including time-based coding and risk assessment.
CENTC: The Certified ENT Coder credential applies to coding for procedures performed by ear, nose and throat specialists and otolaryngologists, such as laryngoscopies and sinus surgeries.
CFPC: The Certified Family Practice Coder credential verifies expertise in determining codes for multiple procedures and services, such as giving injections, caring for broken bones and taking medical histories.
CGIC: The Certified Gastroenterology Coder credential covers correct coding for common gastroenterological procedures and surgeries, such as colonoscopies and esophageal dilations.
CGSC: A Certified General Surgery Coder credential focuses on services typically offered in this specialty, such as teaching situations, shared visits, consultations and operations, including hernia repairs and transplants.
CHDA: The Certified Health Data Analyst credential demonstrates mastery of health data analysis, including the ability to take data and transform it into useful information quickly and accurately.
CHONC: The Certified Hematology and Oncology Coder credential shows a coder’s knowledge of the medical practice of hematologists and oncologists, including cancer-related procedures like chemotherapy, bone marrow biopsies and other services.
CHPS: The Certified in Health care Privacy and Security credential is for professionals who specialize in the privacy and security of health care information and demonstrate the ability to design, implement and administer privacy and security protection programs.
CHTS: The Certified Health care Technology Specialist exams are for health IT professionals who want to validate their competency in various topics, including workflow assessment, certain hardware and software, problem diagnosis, and system tests and installations.
CIMC: The Certified Internal Medicine Coder credential concentrates on coding for procedures typical in an internal medicine practice, such as injections and skin tag removals.
CIRCC: The Certified Interventional Radiology Cardiovascular Coder credential was created to reduce the field’s high error rates. This certification validates individuals who display advanced knowledge of diagnostic angiography, non-vascular interventions, percutaneous vascular interventions, diagnostic cardiac catheterization and basic coronary arterial interventions.
COBCG: The Certified Obstetrics Gynecology Coder credential provides verification of familiarity with coding for obstetric services and deliveries as well as OB/GYN surgical procedures, such as hysterectomies and biopsies.
COSC: The Certified Orthopedic Surgery Coder credential can assure an employer of a candidate’s proficiency in coding for procedures that orthopedists typically perform, including arthroscopies and fracture repairs.
CPCD: The Certified Professional Coder in Dermatology credential specializes in coding of surgical procedures common for dermatologists, such as skin debridement or the removal of damaged tissue.
CPEDC: The Certified Pediatrics Coder credential can show experience in coding services and procedures relating to health care for children, such as injections, vaccinations, vision testing and foreign body removal.
CPRC: The Certified Plastic and Reconstructive Surgery Coder credential demonstrates expertise in coding for procedures and services offered by plastic and reconstructive specialists, including scar revisions and cosmetic surgeries.
CRHC: The Certified Rheumatology Coder credential focuses on coding surgical procedures, such as joint injections that are often billed in rheumatologists’ practices and rheumatic disease treatment. This credential also includes coding for conditions like carpal tunnel syndrome, fibromyalgia, rheumatoid arthritis and numerous other diagnoses.
CSFAC: The Certified Surgical Foot & Ankle Coder credential can verify the experience of coders working with podiatrists, orthopedists and medical facilities that offer consultations, services and surgeries specifically for feet and ankles.
CUC: The Certified Urology Coder credential offers verification of experienced coding procedures and surgeries common to this specialty, such as urinalysis, injections, cystoscopies, biopsies and others.
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