Medical Billing and Coding Certification

Medical Billing and Coding Certification and the organizations that offer these credentials. Learn what certification is and the benefits to being a certified Medical Billing Specialist or Certified Professional Coder.

What is Certification?
Professional medical billing and coding certification is a designation earned by an individual as proof that a minimum level of competency. Certification typically follows graduation from a formal training program and requires passing a certification exam. The certification is usually earned from a professional society and valid for a defined time, such as 1 year. These certifications must be renewed on a periodic basis and require evidence of completion of continuing education units (CEU’s) and maintaining membership in the granting professional society.

Certification is different from being licensed. Licensing is typically required by state government agencies to demonstrate a minimum level of knowledge or ability as required by law.

Benefits of Medical Billing and Coding Certification

  • Distinguishes you from others - gives you an advantage when applying for job over those not certified.
  • Shows your commitment to the profession - Shows management that you are improving.
  • Improves income potential.
  • Demonstrates a basic level of knowledge about the profession.
  • Commitment to ethical responsibilities of the profession.
  • Improved opportunities for advancement.

There's not a combined medical billing and coding certification, but there are separate certifications available for Medical Billing and Medical Coding. Medical coding certification is more diverse and involved due to the complexity of coding.

Independent home based medical coders and billers benefit from certification for marketing your credentials to potential clients.

Medical Billing Certification
Especially when it comes to medical billing, certification can be a topic of spirited discussion.

Quite honestly as long as I've been in medical billing both as an employee and business owner I have never been asked if I am credentialed in billing. Certification certainly enhances your credibility and salary potential.

AMBA - Certified Medical Reimbursement Specialist
The American Medical Billing Association (AMBA) is probably one of the most recognized organizations offering medical billing certification through examination and education.

The Certified Medical Reimbursement Specialist (CMRS) is an exam based certification that demonstrates a knowledge in insurance reimbursement, medical terms, coding (ICD9, CPT4 and HCPCS), claim appeals, and compliance (HIPAA and OIG).

The CMRS exam has 16 sections with 700 questions. A minimum score of 85% is necessary to pass and recieve the CMRS credential designation.

The CMRS Exam is divided into 16 Sections:

  • Medical Terminology
  • Anatomy and Physiology
  • Information Technology
  • Web and Information Technology
  • ICD-9-CM Coding
  • CPT-4 Coding
  • Clearinghouses
  • CMS 1500
  • Insurance
  • Insurance Carriers
  • Acronyms
  • Compliance
  • Fraud and Abuse
  • Managed Care
  • General
  • Case Study

Maintaining certification requires obtaining 15 continuing education units (CEU’s) from an approved listing every year. Cost is $325 plus membership in AMBA.

AMBA recognizes the CEU’s from courses offered by the AAPC (American Academy of Professional Coders) and many other reputable organizations.

AAPC Certified Professional Biller (CPB)
The American Academy of Professional Coders now offers an exam based certification for professional billers called the CPB - Certified Professional Biller. The organization recommends having an Associates degree before attempting to take the certification exam and requires maintaining AAPC membership.

The CPB certification exam consists of 200 multiple choice questions covering everything from:

  • Types of Insurance
  • Collections & Reimbursement
  • Compliance & Regulations
  • HIPAA
  • Coding
  • Billing

Taking the exam currently costs $300 ($260 for AAPC students) and takes an estimated 5 hours and 40 minutes. It's an open book exam and can be re-taken for free within one year of the first attempt. This is an excellent credential for an insurance billing specialist to consider.

Healthcare Billing and Management Association
The Healthcare Billing and Management Association offers the Certified Healthcare Billing & Management Executive (CHBME) and Certified Medical Billing Associate (CMBA). However these tend to be designed more for executives, managers, and supervisors.

Probably the highest level of credentialing offered for medical billing and reimbursement is the RHIA and RHIT certifications offered by the AHIMA (American Health Information Management Association).

RHIA stands for Registered Health Information Administrator. They are mostly involved with the management of patient health information, medical records, and computer information systems.

RHIT stands for Registered Health Information Technician. They are health information technicians associated with medical records and computer applications and systems.

Medical Coding Certification
Many desiring medical billing and coding certification pursue credentials administered by two different reputable professional coding organizations - AAPC (American Academy of Professional Coders) and the AHIMA (American Health Information Management Association).

Before pursuing medical billing and coding certification from AAPC or AHIMA, consider your career path and what credentials your preferred employer requires. If the type of setting or employer requires CCS credentials, then your goal would be to pass the AHIMA certification exam. If they require CPC credentials, then AAPC is the credentialing and exam authority.

You may also talk with an experienced professional already in the coding field and get their opinion on which credentials to pursue.

Here's a summary of AAPC and AHIMA certifications:

AAPC Certifications

  • CPC - Certified Professional Coder
  • CPC-H - Certified Coding Specialist - Hospital
  • CPC-P - Certified Coding Specialist - Payer
  • CIRCC - Certified Interventional Radiology Cardiovascular Coder
  • AAPC also offers 20 specialty credentials.

Other AAPC Certifications

  • CPMA - Certified Professional Medical Auditor
  • CPCO - Certified Professional Compliance Officer

AAPC is a national group dedicated to advancing the medical coding profession and currently has over 106,000 members with over 64,000 certified. AAPC was founded in 1988 to provide education and professional certification for physician-based coders and to raise medical coding standards through training, certification, continuing education, networking, and job opportunities.

The AAPC provides certified credentials for medical coders working in physician offices, surgical centers, outpatient facilities, and in insurance payers. Being credentialed by AAPC requires members to agree to a Code of Ethics to uphold high standards of integrity, ethical behavior, and professionalism.

AHIMA Coding Certifications

  • CCA - Certified Coding Associate. This is an entry-level certification.
  • CCS - Certified Coding Specialist. More proficient coders.
  • CCS-P - Certified Coding Specialist - More proficient Physician Based coder.
  • CHDA - Certified Health Data Analyst

Other AHIMA Certifications

  • RHIA - Registered Health Information Administrator
  • RHIT - Registered Health Information Technician
  • CHDA - Certified Health Data Analyst
  • CHPS - Certified Healthcare Privacy and Security

AHIMA is dedicated to the effective management of personal health information required to administer healthcare to the public with over 61,000 members. AHIMA was founded in 1928 with the goal of improving the quality of medical records. The organization is committed to advancing the health information management profession by advocacy, certification, and education, The majority of coding students who pursue AHIMA certification sit for the Certified Coding Associate (CCA) certification exam.

Career Advantage
Obtaining medical billing and coding certification shows your commitment to the profession. It shows that your committed enough to spend the time and effort to get certified. It also shows you are committed to high standards for professionalism, integrity, and ethical behavior.

To a potential employer or client certification is a big selling point. The less experience you have, the more beneficial certification can be in the job market.

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