Advanced Certification Guide in Medical Billing and Coding

A Medical Billing and Coding certification will help you learn and enhance your career or promotion to next level. In this article, you would learn about

  • The advantages of getting an advanced certification
  • The advanced certification programs available and the exams you will need to pass
  • The prerequisites to become certified
  • How to prepare and ace your certification exam

This guide focuses on the certifications for an experienced medical billing and coding professional who has already acquired the beginner level certifications. If you are a beginner or have only few years of experience as a professional coder and is planning to get a certification, you may check the guide for beginner certifications.

The Benefits of Becoming Certified

As in any career, getting an industry recognized medical coding and billing certification assures your potential future employer that you are serious about your career as a medical biller or coder and have the professional qualifications to do your job. Preparing for the advanced level certifications also helps you learn skills that will help you specialize in an area of your choice, such as professional, inpatient or outpatient coding which distinguishes you to the employer looking for senior level coders.  

Medical Coding Certifications

The American Academy of Professional Coders (AAPC) and the American Health Information Management Association (AHIMA) offer the top medical billing and coding certifications valued by most employers. AAPC and AHIMA are the most reputable national medical coding certification organizations, and both offer medical billing and coding certification courses, study materials and exams.

Certified Outpatient Coding (COC)

AAPC’s COC certification exam tests students’ knowledge of the coding procedures and guidelines that relate specifically to outpatient facilities such as ambulatory surgical centers or hospital outpatient coding departments.

Certified Inpatient Coder (CIC)

AAPC’s COC certification exam tests students’ knowledge of the coding procedures and guidelines that relate specifically to inpatient hospital or facility coding departments.

Certified Coding Specialist-Physician-based (CCS-P)

Recipients of AHIMA’s CCS-P certification are professionals who have achieved mastery of the coding practices used in physicians’ offices. This credential requires at least 3 years of work experience and expertise in medical office management in addition to earning the medical billing certification online.

If you are already CPC certified, COC and CIC from AAPC are the next level certifications that you can consider. The COC is easier after obtaining the CPC as the major difference that would need additional preparation would be the different payment methodologies. The CIC includes additional topics from CPC such as Medical Records and Healthcare documentation guidelines and Coding cases which would need you to study and prepare more before you can pass the exam. If you plan on getting both additional credentials, it would probably be easier to try the COC which may not require a lot of additional preparation and then to try for the CIC.

If you are already CCS certified and is working in a physician practice doing professional coding, CCS-P is the next level certification for you.

Medical Billing Certifications

The billing credentials  Certified Medical Reimbursement Specialists (CMRS) and Certified Professional Biller (CPB) are the industry leading certifications for medical billing.The guide to these credentials are available on in the beginner’s guide to certifications.

Certification Requirements

It is not necessary to earn a degree prior to taking a certification exam, but employers do prefer to hire candidates who have associate’s degrees in the field. An associate’s degree in medical billing and coding indicates that the candidate has a broader knowledge of the field as a whole compared to those who have only completed the certification exams.

In order to sit for COC exam, you must submit proof that you have had at least two years of on the job experience as a medical coder unless you have passed CPC exam with an apprentice status and have the CPC-A credential.There are no educational requirements for CIC. Both COC and CIC need you to be a member of AAPC to sit for the exam. An overall score of 70% is required to pass both the exams.

There are many options in order to be qualify yourself for the CCS-P certification exam. You can sit for the exam if you are RHIA, RHIT or CCS certified or have completed an educational program that covers anatomy & physiology, pathophysiology, pharmacology, medical terminology, reimbursement methodology, intermediate/advanced ICD diagnostic coding, and procedural coding and medical services (CPT/HCPCS) or have two years of coding experience or have a coding credential with one year of coding experience.

The Costs of Becoming Certified

The cost of a certification at minimum is the cost to sit for the exam. You may also need a training or books in order to prepare for the exam which are additional costs to be considered. include the training fee for certification preparation and the exam fee. The training cost can vary depending on your individual need and the training you choose.

The fees to sit for the exam also varies depending on if you are a student or a member of the certifying organization. The member rates for the certification are lower such that it is better to become a member if you are planning for the certification.

The regular fee to sit for the certification exams, including the membership fee to join the organization, is below:

Fee Type COC or CIC CCS-P
Membership Fee Individual: $60

Student Non-AAPC: $110

Student AAPC: $90

New to AHIMA: $79

Active: $135

Student: 49

New Grad: $79

Premier Member: $199

Exam Fee Individual/Student Non-AAPC: $380 (includes one re-take)

Student AAPC: $300 (includes one re-take)

Premier Member: $284.05

Member: $299

Non-member: $399

The Certification Exam

The COC exam checks your knowledge on CPT®, HCPCS and ICD-10-CM diagnosis codes used for coding and billing outpatient facility or hospital and freestanding ASC services. The exam duration is 5 hours 40 minutes and has 150 multiple choice questions.

The CIC exam checks your knowledge on CD-10-PCS procedure codes and ICD-10-CM diagnosis codes used for coding and billing inpatient facility or hospital.The exam duration is 5 hours 40 minutes and has 60 multiple choice and 10 inpatient case fill in the blank type questions.

The CCS-P exam checks your knowledge the CPT coding system and familiarity with the ICD-10-CM and HCPCS Level II coding systems. The exam duration is 4 hours and has 97 multiple choice questions and 8 medical scenarios.

Exam Locations

All AAPC Certifications including COC and CIC are proctored by AAPC staff, approved AAPC instructors, and local chapter officers. You can easily locate an exam center near to your home as there are many proctors available who are providing this service. You can locate an exam center and schedule exam from the AAPC website here.

AHIMA has partnered with Pearson Vue to facilitate the exams including CCS-P. You can locate a pearson vue test center and schedule the exam by heading on to their website here. To schedule the exam, you must have applied and received your eligibility number and scheduling information from AHIMA website.

The Next Steps

Now that you have read through the guide, is aware of the reasons why a certification is important for your career, and the different certifications available with the qualifications and cost for each of them, it would be good to decide which certification is suitable for you.

We will guide you on the on the best route to prepare for the certification, covering self-study, online practice exams and attending classes in the training section. Whatever certification you choose, and whichever method you decide to study for your exam, you are taking an important step in your next career progression.

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