Beginner’s Certification Guide in Medical Billing and Coding

Certification

A certification is a great initial stepping stone to a career in Medical Billing and Coding. Medical billing and coding certificates introduce you to the  profession with an overview on electronic health records management, medical insurance, and administration and case management. The certificates also help you to pursue entry-level roles as a medical billing and coding professional.

In this article, you would learn about

  •     The advantages of getting a certification
  •     The different certification credentials and the exams you will need to pass
  •     The prerequisites to become certified
  •     How to prepare and ace your certification exam

This article focuses on the certifications at the beginning of your career as a Medical Coding professional. If you have many years of experience as a professional coder and is looking for certifications to advance your career, you may check the advanced certifications section.

The Benefits of Becoming Certified

As in any career, getting an industry recognized certification assures your potential future employers that you are serious about the career as a medical coder and have the professional qualifications to do your job. Many employers also want you to have some knowledge of medical terms and the process before being hired and a medical billing and coding certification is a way to prove that you have this knowledge.

If you are already working as a coding professional, certification is a boost to your career as you acquire knowledge on a broader spectrum of topics related to your career thus enabling you to do your job more efficiently or to get promoted to next level. It would also be better for you to take one of these beginner certifications before you can look at getting certified in one of the advanced ones.

Medical Coding Certifications

The American Academy of Professional Coders (AAPC) and the American Health Information Management Association (AHIMA) are the most reputable national medical coding certification organizations, and both offer medical coding certification courses, study materials and exams. As a beginner in medical coding, below are the certifications available to you from AAPC and AHIMA.

Certified Professional Coder (CPC)

AAPC’s CPC courses teach coding fundamentals and codes used in outpatient clinics and medical offices. The CPC credential examination tests students’ knowledge of anatomy and medical terminology as well as their ability to utilize relevant coding guidelines and practices.

To earn this certification, you must:

  • Pass an exam. You must take an exam covering 24 different areas, including medical terminology, diagnostic codes, coding guidelines and specific coding for more than a dozen specific fields.
  • Demonstrate on-the-job experience. Show that you have spent two years working with CPT, ICD and HCPCS codes — or that you have had 80 hours of coding education.
  • Engage in ongoing education. Complete 36 hours of continuing education every two years to keep up with new medical treatments and changing coding regulations.

Certified Coding Associate (CCA)

AHIMA’s CCA credential certifies that recipients have a broad understanding of the coding practices used across all types of medical settings. This medical billing online certification qualifies students for an entry-level job assigning codes to the diagnoses and procedures described in patient medical records.

Certified Coding Specialist (CCS)

AHIMA’s CCS credential is for professionals who have mastered the coding skills and systems used in hospitals. In order to qualify to take the certification exam, students must first graduate from a school that is accredited by the Commission on Accreditation for Health Informatics and Information Management Education (CAHIIM).

Medical Billing Certifications

Most certifications preferred by employers are focused on medical coding, though the American Medical Billers Association (AMBA) and American Academy of Professional Coders (AAPC) does offer medical billing certifications. This is more so because billing jobs generally require less specialized knowledge than coding jobs and no state or Federal requirements require a medical biller to be certified to practice medical billing.

Certified Medical Reimbursement Specialists (CMRS)

AMBA’s CMRS credential certifies that the medical billing professional has a good understanding of the billing process. In order to take the exam, you must be a member of AMBA and must have a high school diploma.

Certified Professional Biller (CPB)

AAPC’s CPB credential certifies that the medical biller is aware of all aspects of revenue cycle.

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. The CPC, CCA and CCS certifications do not require a college degree to sit for the exams.

For the CPC exam through the AAPC, there are no educational requirements though an associate degree is preferred. But you have to submit proof that you have had at least two years of on the job experience as a medical coder. Else you would be awarded with an apprentice status also called a CPC-A certification. You can remove the apprentice status whenever you have acquired on the job experience by submitting two letter letters of recommendation verifying at least two years of on the job experience.

In order to qualify to sit for the CCA exam, you must have a high school diploma and preferably a medical coding experience of six months. For the CCS through AHIMA, you need to have completed an educational program that covers the following: anatomy & physiology, pathophysiology, pharmacology, medical terminology, reimbursement methodology, intermediate/advanced ICD diagnostic/procedural and CPT coding, OR 2 years of coding experience, OR CCA or other coding credential and 1 year of coding experience.

All certification examinations require that you become a member of the certifying organization by paying a membership fee, in addition to the exam fee.

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 CPC CCA CCS
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

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

Premier Member: $284.05

Member: $299

Non-member: $399

Both AAPC and AHIMA often have discounts and promotions that allow you to register for the exams for a lower fee rate than the regular fee. If you are planning to get certified and have the option to wait for some time before you sit for the exam, you may check the organization websites periodically to find such promotional rates.

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