Medical Billing and Coding Certification: CPC, CPB an More

If you're looking to break into the health care industry, getting certified in medical billing and coding could be a great place to start. Modern health care policies require organizations with professionals who can accurately and efficiently use these tools to manage patient billing and coding. In this blog post, we'll explore what medical billing and coding entails, how to get certified in this field, and why certification is important. Keep reading to learn more about how to get certified for medical billing and coding.

Overview of Medical Billing and Coding

A certified medical billing and coding professional is responsible for entering and updating patient billing and coding information. This data is used to track patients' medical records, verify insurance coverage, process claims, and generate reports. They must also adhere to regulations, such as the Health Insurance Portability and Accountability Act (HIPAA). Billing practices follow the credentialing guidance and legal requirements of insurance companies and the health care system. This is why education and certification is so important for any medical billing and coding position.

What is Medical Billing and Coding?

Medical billing and coding is the process of making sure that claims for reimbursement for medical services are correctly and accurately processed. The coding part of that process is matching the services provided to appropriate billing codes. The billing is creating insurance claims and patient bills. It also  includes verifying insurance eligibility and benefits and responding to requests from insurance companies.

Insurance companies only cover certain medical coding diagnoses and procedures, and billing professionals often have to match codes to medical records to make sure they match. A good billing and coding specialist will get proper reimbursements from insurance companies, which can reduce costs for the patient.  

The medical billing and coding environment is vital for the success of each health care organization. Billing and coding excellence prevents fraud and provides financial transparency for patients who are dealing with the cost of health care delivery.

Benefits of Medical Billing and Coding

Medical billing and coding is an important and in-demand occupational field. Certified professionals can enjoy the benefits of flexible hours, excellent salaries, job security, and a career in a growing industry. Some dually certified billing and coding professionals make over $60,000 annually, and some are able to do this while working from home.This could be great for professionals who want a work-life balance and flexibility to pursue life goals outside of work.

What are the Requirements for Medical Billing and Coding Certification?

The certification requirements for medical billing and coding professionals provides opportunities for many people regardless of post-secondary education. These opportunities include lateral and vertical career mobility, job security, transferable skills, and professional credibility.

Educational Requirements

In order to become certified in medical billing and coding, you must have a high school diploma or equivalent, such as a GED. This is the lowest requirement, and there are opportunities available with further education.

Professional Experience Requirements

Some certifying organizations require that medical billing and coding certification candidates have at least two years of relevant experience or have completed a postsecondary medical billing or coding program.

Why Get Certified

Getting certified in medical billing and coding is a good way to demonstrate your expertise and experience in this field. Many employers prefer to hire certified professionals over those without certifications. Certification also allows you to demonstrate your commitment to the profession and opens the door for more job opportunities and higher salaries.

The certification process also builds confidence in quality billing and coding practices. Professionals who obtain certification are more likely to experience job satisfaction as a certified professional. The certification also enhances job security and transferable skills in the event of a location change.

Types of Medical Billing and Coding Certifications

There are many medical billing and coding certifications available, and each certification is an achievement that shows advancement and professionalism. Some certifications may be relevant in only certain healthcare facilities. Professionals often start with basic certifications and build upon them when it will enhance their careers.

CPC – Certified Professional Coder

The CPC (Certified Professional Coder) is a certification awarded by the American Academy of Professional Coders (AAPC). It is the most widely recognized and respected billing and coding credential in the industry.

Passing the CPC means you may work in a medical clinic, lab, or telehealth company. It does not always qualify you to work in a hospital setting or ambulatory surgery center.

CPC + CPB – Certified Professional Coder + Certified Professional Biller

The CPC + CPB certification combines the CPC certification with the CPB (Certified Professional Biller). This dual certification makes you an expert in both medical billing and coding.

COC – Certified Outpatient Coder

The COC (Certified Outpatient Coder) is an advanced certification awarded by the AAPC. It certifies your knowledge of outpatient coding protocols and specializes you in coding services provided in a variety of ambulatory care settings.

CIC – Certified Inpatient Coder

The CIC (Certified Inpatient Coder) is another advanced certification that certifies your knowledge of inpatient coding protocols. This certification is ideal for professionals who code services provided in a hospital setting.

CRC – Certified Risk Adjustment Coder

The CRC (Certified Risk Coder) certification is the most advanced certification offered by the AAPC. It certifies your knowledge of risk adjustment coding protocols and prepares you to work in the field of risk adjustment coding.

CPMS – Certified Professional Medical Scribe

The CPMS (Certified Professional Medical Scribe) certification is offered by the American Medical Scribe Association and certifies your knowledge of medical scribing, a growing field in the medical billing and coding industry. This is a position that requires working in a clinical setting in most cases, and it is perfect for professionals who want more access to the medical process.

CPB – Certified Professional Biller

The CPB (Certified Professional Biller) certification is offered by the American Academy of Professional Coders and certifies your knowledge of medical billing, including patient data entry and claim submission.

CPMA – Certified Professional Medical Auditor

The CPMA (Certified Professional Medical Auditor) certification is offered by the American Academy of Professional Coders and certifies your knowledge of medical auditing, including data entry and claim review.

CPCO – Certified Professional Compliance Officer

The CPCO (Certified Professional Compliance Officer) certification is offered by the American Academy of Professional Coders and certifies your knowledge of compliance regulations, including HIPAA and fraud prevention.

Other certifications

Other certifications are available, such as the CDEO (Certified Documentation Expert Outpatient), CDEI (Certified Documentation Expert Inpatient), and CPPM (Certified Physician Practice Manager). There are also many specific certifications for specific industries such as emergency department coders (CEDC) or cardiology coders (CCC).

Each certification fills needs that are specific to certain organizations, and some are not relevant for entry-level positions but rather for advancement opportunities.

Certification Organizations

There are two primary certification organizations for medical billing and coding professionals. These organizations have the training needed to ensure billing and coding standards are met. This minimizes errors and fraud. Certifications from these organizations indicate that you are willing to abide by professional standards and are familiar with procedures necessary to facilitate fair and legal billing practices.

AHIMA

The American Health Information Management Association (AHIMA) is a primary certifying organization for medical billing and coding professionals. AHIMA offers a variety of certifications, including the Certified Coding Associate (CCA), Certified Coding Specialist (CCS), and Certified Coding Specialist-Physician-based (CCS-P).

AAPC

The American Academy of Professional Coders (AAPC) is also a primary certifying organization for medical billing and coding professionals. AAPC offers a variety of certifications, including the Certified Professional Coder (CPC) and Certified Professional Biller (CPB).

How to Prepare for Certification

Many people pursuing careers in medical coding and billing do not know where to begin. The certifications and certifying agencies can be an overwhelming world filled with acronyms and difficult terminology. The following steps will help you to begin your professional journey as a medical coder or billing specialist.

Research Credentialing Organizations

Before you begin preparing for a certification exam, it's important to research the certifying organization and the requirements for becoming certified. This will help you determine which certification is best suited for your professional goals. Especially if you are already employed and looking for advancement opportunities, it is very important to make sure the certification you pursue is in line with your goals.

Take Courses and/or Training Programs

You can prepare for medical billing and coding certification exams by taking courses or training programs. The two most common organizations that offer these certifications are the AHIMA and the AAPC These courses are typically offered by colleges, universities, and professional organizations and cover topics such as medical terminology, coding regulations, medical law and ethics, and more. Most of the courses are available online.

Become Familiar with Terminology

To prepare for medical billing and coding certification exams, you'll need to become familiar with medical terminology. This includes terms related to anatomy, physiology, diseases, treatments, and pharmacology. A formal medical terminology course from an educational institution is best.

Study for Exams

In addition to taking courses and becoming familiar with medical terminology, you'll need to study for the certification exams. This includes reading textbooks, participating in online forums, and taking practice exams. The exams are challenging, and studying should not be an afterthought.

Tips for Passing Medical Billing and Coding Certification Exams

To successfully pass a medical billing and coding certification exam, it's important to take the time to properly prepare. Here are some tips to help you prepare for and pass the exam:

• Be familiar with the material: Make sure you are familiar with the material covered on the exam by reading textbooks and taking practice exams. Join study forums or create a study group if that is an option.
• Develop a plan: Develop a study plan that works for you and stick to it. Last-minute cramming is not the best path to passing the exam, and slow and steady study habits will ensure that you know the material.
• Take practice exams: Take practice exams to get an idea of the types of questions you can expect on the certification exam. Proctored tests are typically multiple choice, but it is good to get an understanding of how the questions are worded and how easily you can answer them.
• Schedule your exam: Make sure you schedule your exam in advance to ensure you are prepared. You may want to schedule this far in advance to make sure you can get to the location and that there are openings. Most exams require a fee, which your employer may cover, but it is important to make sure the amount of the exam is covered or will be covered before you get started prepping for certification.
• Get organized: Make sure you are organized and have all of the materials you need for the exam. Coding and billing practices are highly organized, and organizational skills learned while prepping for certification will transfer to the work environment.

Benefits of Certification

Having a medical billing and coding certification can provide you with a variety of benefits, such as:

• Increased job opportunities
• Higher salaries
• Increased recognition
• More job security
• The ability to work in multiple health care settings
• The potential to have an accelerated career path
• Pride as a certified professional

Higher Education

If you are looking to take your medical billing and coding career to the next level, you may want to consider pursuing a higher degree. There are associate's and bachelor's degrees available in medical billing and coding. An associate's degree usually takes two years to complete and a bachelor's degree usually takes four years. A higher ed degree will allow you to qualify for higher-level positions within the field and will provide you with the opportunity to advance your career.

Some health care organizations may prefer job candidates with a 2-year or a 4-year degree. Other organizations may offer the opportunity to increase salaries or positions if pursuing a higher-ed degree. In most cases, these degrees are not necessary for entry-level positions. They may be required for advancement.

Opportunities in Medical Billing and Coding

According to the U.S. Bureau of Labor Statistics, medical coders are classified as medical records specialists with a median income of $46,660 per year. Medical billing specialists have a median wage of $41,610 to $43,290 depending on whether they are in a physician's office or hospital. By becoming certified in medical billing and coding, you can open the door for more career opportunities, higher salaries, and job security. With this comprehensive guide, you now have all the information you need to become a certified medical billing and coding professional.