Certification in Medical Billing

Confused by the different certification in medical billing credentials? Here's the top ones to help you sort it out and determine which is best for you. Also includes the cost and the professional organizations that offer them.

When the topic of medical billing certification comes up, it can be a topic of spirited discussion. Being credentialed in medical billing has not traditionally been very prevalent.

And that has probably hurt the perception of the profession. As compared to medical coding which has always encouraged certification and recognized it benefits. It also enhanced the perception of the individual and the profession as a whole. Certification for medical billing is also an advantage whether seeking a job or consultant opportunity as it conveys professionalism and evidence you meet high standards.

So here's the organizations offering certifications in medical billing and their requirements.

AMBA - Certified Medical Reimbursement Specialist

The American Medical Billing Association (AMBA) offers medical billing certification through education and exam. The Certified Medical Reimbursement Specialist (CMRS) is an exam based certification that demonstrates a knowledge in insurance reimbursement, medical terms, coding (ICD-9, CPT-4 and HCPCS), claim appeals, and compliance (HIPAA and OIG).

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

The CMRS exam is given through a secure online system. It allows 45 days to access and complete the test which has 16 sections with 700 questions. A score of 85% is required to pass the exam and receive the CMRS designation.

The 16 sections of the CMRS exam are:

• 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

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 has long been one of the most popular credentialing associations for medical coders. They now offer an exam based certification in medical billing called the CPB - Certified Professional Biller. AAPC 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 and takes an estimated 5 hours 40 minutes to finish. Topics covering:

• Types of Insurance
• Insurance claim process and revenue cycle
• Collections & Reimbursement
• Forms and Regulations
• HIPAA
• ICD and HCPCS Level II Coding
• Follow Up on denied claims and patient responsibilities
• A case analysis

AAPC offers an online course (cost $995) and practice exam to help in preparing for the exam. This is an excellent credential for someone wanting to specialize in billing.

MAC - Medical Association of Billers         

The Medical Association of Billers was founded in 1995 as a training and credentialing organization for medical billing and coding.

MAC offers the Certified Medical Billing Specialist program for certification and intended for those working for providers, insurance companies, or billing services. Certification can be obtained by completing six online courses, take what is called a “PowerWeekend”, or take a proctored exam. This can be completed anywhere from a weekend to 6 months.

The CMBS exam consists of 100 questions. Maintaining certification requires membership in MAC and completion of 12 continuing education units (CEU’s) each calendar year.

The Medical Association of Billers offers the following certification in medical billing:

• CMBS-H Certified Medical BIlling Specialist for Hospitals

• CMBS-CA Certified Medical Billing Specialist for Chiropractic

• CMBS-I Certified Medical Billing Specialist Instructor

The CMBS exam is proctored at a location having an agreement with the MAC. Cost of examination is $199 and requires membership in the Medical Association of Billers which is $115.

HBMA - Healthcare Billing and Management Association 

The Healthcare Billing and Management Association offers the Certified Healthcare Billing & Management Executive (CHBME). HBMA explains that this credential is “designed for owners, senior management and compliance professionals of HBMA Member Companies.” So I don’t know that this is really a certification in medical billing as we think of it. It’s really a credential intended for leaders and executives in healthcare reimbursement - which includes medical billing.

The highlights of CHBME certification are:

• Financial Management - Accounting, reporting, & funding.
• Legal Operations - Corporate structure, human resources, contracts, compliance, and other risk management topics.
• Marketing - Pricing, sales, and web services.
• Technology - Software, security (HIPAA/HITECH), communications, & automation.
• Strategic Planning - Objectives, core competencies, target markets, succession planning, disaster planning and recovery.

An examination is required to receive CHBME certification and 60 continuing education credits. 80% of the continuing education credits must be through a HBMA sponsored program.

Cost is $350 for application and a $150 annual maintenance fee.

Summary

Certification in medical billing is offered by the four different professional organizations covers the whole spectrum of healthcare billing - from the physician office to the executive. Depending on your career objectives, there are credentials for just about any situation. I would encourage you to check out these organizations, become active members and obtain certification.

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