By earning them, those students become certified medical billers and coders. They are also eligible to avail themselves of their related career opportunities in the healthcare sector.
The certification for medical billing and coding is mostly voluntary. However, students have to undertake them since most coding and billing jobs either require or highly recommend them.
The three types of certification comprise the American Association of Professional Coders, the American Medical Billing Association, and the National Healthcareer Association. Let’s take a look at them in detail:
The American Association of Professional Coders is a specialized association that provides certification for medical billing and coding. The certification for medical billing is called Certified Professional Biller. The certification for medical coding is titled as Certified Professional Coder.
You have to initially pass an exam to avail yourself of this type of certification. The exam contains questions about all aspects of the medical coding and billing professions. Its duration is 5 hours and 40 minutes and includes 200 questions.
You have to complete the exam in one sitting and score a percentage of 65% or more to pass it. It mostly contains questions about the types of insurance, medical case studies, and billing and coding regulations. It especially focuses on HIPAA compliance and reimbursement regulations.
American Medical Billing Association is a billing organization that specifically works for medical billers. Its certificate is titled Certified Medical Reimbursement Specialist (CMRS). You have to pass the exam and answer more than 800 questions divided into 16 technical sections.
The major sections of that exam comprise CPT coding, anatomy and physiology, medical terminology, and case studies. There are other sections as well, like information technology and computers, fraud and abuse, and ICD-10-CM coding.
You can remotely attempt this exam and have to submit it in less than 45 days after signing up. It requires a score of 85% or higher for you to pass and earn the CMRS certification for medical billing and coding.
National Healthcareer Association has a single certification titled Billing and Coding Specialist, which works for both medical billing and coding. The exam contains technical questions that comprehensively cover the knowledge and training required to execute their processes.
You have to pass that exam in order to successfully avail yourself of this certification. The exam contains 100 questions, and you have to answer them within two hours. It is usually administered in medical schools or training centers, where you have to complete it in one sitting.
Those questions cover a variety of topics related to medical billing and coding. The important topics for this exam include claims processing, payment adjudication, and regulatory compliance. You should also focus on the application of coding knowledge and front-end duties.
The following is a list of top certifications that you can avail of to become a certified medical biller and coder. With them, you can become licensed to provide billing and coding services anywhere in the country.
This certification for medical billing and coding equips you with the necessary expertise to assign codes. They are assigned to medical treatments and procedures. These medical services require verified practice as they are provided in an inpatient setting.
You can easily manage the codes involved in the ICD-10 Clinical Modification and Procedure Coding System. This certificate enables you to effectively conduct several aspects of facility and hospital inpatient coding. Its exam is four hours long and contains 40 multiple-choice questions.
There are also seven fill-in-the-blanks specifically targeting inpatient cases. You must have solid concepts of the application of ICD-10-CM diagnosis codes and ICD-PCS procedure codes. You are also expected to have your own codebook throughout the duration of your exam.
You can avail of this certification to certify your coding skills in assigning codes to the medical services executed in outpatient groups. The certificate is a documented record of your eligibility to work on surgical and hospital cases. Their patients do not stay for more than a day.
You must meet certain prerequisites in order to avail yourself of this certification. They comprise an active AAPC membership and at least two years of experience in medical coding. The exam has 100 multiple-choice questions, which must be completed within four hours.
You must correctly answer 70 or more questions to earn the credential. Successful candidates can renew their certified license if they have an annual AAPC membership. They are also required to complete at least 36 Continuing Education Units after every two years.
Certified Medical Coder is an advanced certification that provides training in specific medical coding guidelines. These guidelines are only targeted to process outpatient claims in hospitals. You can avail of this certification from the Practice Management Institute.
It has certain prerequisites that must be fulfilled before applying. You should at least have one year of experience in assigning medical codes for outpatient cases. You can complete some foundational training courses to substitute for the experience requirement.
You are also required to complete the medical coding assessment of the Practice Management Institute. It identifies potential knowledge gaps in your current expertise before you start training. Completing that assessment makes you eligible to take the exam.
The Certified Professional Coder certification trains you to manage several domains of the medical coding field. However, it can be considered a certification for medical billing and coding since it covers billing codes as well.
You must have an active AAPC membership and at least two years of medical coding experience to apply. As an alternative, you are also eligible if you are an associate degree holder in either medical coding or billing.
There are 100 multiple-choice questions in the exam about routine topics like pathology, anesthesia, ICD-10-CM codes, and medical terminology. You can be selected for the Certified Professional Coder – Apprentice certification instead if you do not have any prior experience.
The American Association of Professional Coders offers this certification for medical billing and coding professionals. These guidelines are based on optimizing the accounts receivable management of healthcare organizations.
As a certified professional medical auditor, you are licensed to apply your coding concepts to prevent fraud and abuse and conduct risk analysis. You are required to have around two years of medical auditing experience with an annual AAPC membership to apply for this certificate.
You can only be selected for the medical billing certification if you successfully attempt its exam in under four hours. There are around 100 multiple-choice questions in the exam. You have to complete 36 hours of Continuing Education Units to renew this certificate after every two years.
Medical professionals avail of this certification to become proficient in analyzing the risk scores of patients for improved outcomes. You can also avail it to increase your efficiency and productivity for assigning codes in a healthcare office setting.
You become better at auditing the risk adjustment models of your medical institute. Furthermore, this certification trains you for intense pathophysiology and anatomy cases. It is ideal for those students who have prior certification in medical billing and coding.
Its requirements are the same as other certifications for medical billing and coding. You have four hours to attempt 100 multiple-choice questions in its exam. You must score at least 70% or more to be selected and get a shot at becoming a certified risk adjustment coder.
This blog explored how certification for medical billing and coding works in the US. We covered three types of certifications offered by the top healthcare associations. Moreover, we also listed down six major certifications along with their content, prerequisites, and future opportunities.
Health Quest Billing has an expert team of well-versed medical professionals in all aspects of certification for medical billing and coding. Contact us today and find out the best certification for you to have a shot at the top billing and coding jobs.
Certifications in the healthcare industry ensure that professionals possess the necessary knowledge and skills to maintain the standard of patient care and administrative procedures.
The certification exam tests a candidate’s expertise in areas such as medical terminology, procedural terminology, ICD-10 codes, HCPCS Level II, and billing procedures, ensuring they meet the industry’s standards.
Yes, understanding insurance claims and procedural terminology is crucial for healthcare providers as it ensures accurate billing and smooth patient care processes.
ICD-10 codes and the HCPCS Level II are integral to Health Information Management as they standardize the classification of diseases and treatments, ensuring consistent patient records across health systems.
While a school diploma might be a starting point, many entry-level positions in the healthcare field, especially for billing specialists, often require or highly recommend professional certifications or formal training from a coding program or certificate programs.
Not all, but many institutions provide an online program for medical billing and coding, allowing flexibility for those balancing work or other commitments.
Proficiency in coding procedures and maintaining accurate patient records is paramount for a Medical Billing and Coding Specialist as it ensures accurate billing and improved patient outcomes.
While some healthcare career paths might necessitate a college degree, others, particularly in billing and coding, can be pursued with a certificate of completion from a recognized training program.
A certification program equips professionals with practical skills and knowledge to manage electronic health records efficiently, ensuring consistent and accurate record-keeping across rural health clinics and other health systems.
No, teaching experience is not a requirement. However, knowledge in areas like diagnostic coding, outpatient coding, and billing procedures is essential, which can be acquired through a dedicated certification program or associate degree program.
Exam fees are not always included in the education program’s cost and may require separate payment when registering at a testing center.
The primary responsibility of a health information specialist is to accurately assign and manage the alphanumeric code, ensuring precise diagnosis and treatment records for improved patient care.