A Complete Guide to Medical Billing Certification

August 29, 2021

medical billing certification

According to the US Bureau of Labor Statistics, medical billing and coding is expected to grow 10% by 2030, making it one of the fastest-growing careers in healthcare. 

Starting a career in the field is a great way to get deep insights into the human anatomy, physiology and healthcare technology during the process of healthcare. Medical billing and coding certification classes allow the students to get hands-on experience in different coding scenarios before one enters the professional world as well as a competitive edge when applying for jobs. 

Medical Billing & Coding Certification

Medical billing and coding certifications verify that you have the knowledge and skills that you have attained formally to successfully perform the job, playing a vital role in giving a boost to your career. Identifying and then selecting the right certification for yourself requires research and time. In this article, we explore the top three must-do certifications for anyone hoping to start a career in medical coding and billings, and the prerequisites for each.

What is a Medical Coding Certification? 

Even though medical coding certification is not a requirement when applying for a job in the field, people with certifications have a higher chance to land a job and earn a better salary than those with no certification. A certification is useful to demonstrate a foundation in medical coding and means you can give better value to your employer as well as being more efficient in your work.

Medical billing and coding certifications often go hand in hand as both deal with medical record-keeping even though there are several distinctions between the two. Where medical coding is used to track the data regarding patient diagnostics and procedures using Current Procedural Terminology and applies the different code sets, medical billing is the process that uses the data from coding and uses it to generate invoices for medical claims reimbursements from insurance vendors.

Certification Bodies

There are two major governing bodies that grant medical billing and coding certifications: The American Health Information Management Association (AHIMA) and the American Academy of Professional Coders (AAPC). 

AHIMA 

The AHIMA provides certifications that are based on health informatics and focus more on efficient management of healthcare data and less on business elements. For members, the fees range from $200-$300 and $300-$400 for non-members. The membership starts from $135 per year for the standard, and there are options for students and first-time members that are even less. 

Along with two certifications specific to health information, AHIMA offers three coding and three 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. 

AAPC 

The AAPC was originally founded with the aim to improve the medical coding standards, and since then has expanded to provide training and certifications to cover various aspects of the healthcare industry. Certifications that are offered include medical coding, medical billing, compliance, medical documentation and practice management. Membership starts from $180 annually. 

What Certifications Should I Get for Medical Billing and Coding?

Medical Billing & Coding

There are numerous medical billing and coding certifications online available to meet the demand of skilled health information professionals. Three of the most common, and the most sought out certifications are Certified Professional Coder (CPC), Certified Coding Specialist (CCS) and Certified Medical Coder (CMC). 

Certified Professional Coder (CPC)

CPC is offered by the American Academy of Professional Coders (AAPC) and is easily the most popular of the coding certifications. Multiple aspects of the medical coding and billing profession are covered in the certification, including procedural codes and processing billing claims in the clinical care process.

The CPC certification exam is divided into 12 sections with a total of 105 questions, with topics ranging from ICD-10 code set, HCPCS, medical terminology and more.

Prerequisites:

  • Associate’s degree in medical billing and coding (recommended, but not required)
  • At least two years of experience in the medical coding field
  • Current member of the AAPC

Certified Coding Specialist (CCS)

If you are looking to jump start your medical coding career at inpatient facilities, the CCS certification is the best choice for you. The CCS is available through the American Health Information Management Association (AHIMA) and is most comparable to CPC.

The exam covers a variety of topics including diagnosis and procedural coding, health data management, reporting guidelines, compliance and ethical issues.

Prerequisites:

  • A diploma or degree from a medical coding training program
  • Two years of medical coding experience
  • An existing medical coding certification plus one year of medical coding experience

Certified Medical Coder (CMC)

This is a less common medical coding certification than the CPC and the CSS, but is being recognized as an increasingly comparable certification. The exam is set to be much tougher than the two and is offered by the Practice Management Institute (PMI). 

Medical Coder

The main difference between the CMC and CPC and CSS is that where the exams for the latter consist of multiple-choice-questions, the former incorporates fill-in-the-blanks after accessing coding scenarios. The CMC exam is also only offered in a live, proctored setting. The CMC exam consists of approximately 133 questions. Examinees must earn a minimum of 70 percent in order to become certified.

Is a Medical Billing Certificate Worth it?

As most certifications, medical billing and coding certifications are definitely worth it. They provide better job opportunities and higher salaries since they prove that you have gone through accredited training and the necessary examination.

The CPC, CSS and CMS certifications have the highest quality standards in the medical billing and coding field. Therefore, most professionals work to get them. These certifications are offered by different agencies that have different certification requirements. Most of them require candidates to take and pass a certification examination that ensures that candidates are properly prepared to get a credential. They can also require candidates to have completed an accredited training program or to have a certain amount of work experience. In conclusion, if you want to further your career as a medical biller and coder, you should get a certification.

Conclusion

Medical billing certifications are a great way to verify your knowledge of the different codes sets used in medical procedures and services when it comes to reimbursement and billing purposes. Certified coders can apply coding guidelines correctly with 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.

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