A medical billing and coding certification is a professional recognition of the expertise, judgment and achievement of a medical billing and coding professional. Despite the fact that medical billing and coding certification is not a legal requirement to find employment as a medical billing and coding professional, professionals with certifications are more likely to be employed and earn a better salary than those who have not earned a certification.
Certification demonstrates an important foundational knowledge of the three aforementioned key code sets, meaning that certified medical coders can be more efficient and by extension, offer more value to their employers.
Interestingly, there are quite a number of certifications that aspiring medical billing and coding professionals can choose to pursue, although three of the most common are the Certified Professional Coder (CPC), the Certified Coding Specialist (CCS) and the Certified Medical Coder (CMC), each of which is offered by a different organization.
Medical billing and coding can vary greatly depending on the healthcare setting a medical billing and coding professional chooses to deploy his or her services, hence it is important that an aspiring medical billing and coding professional chooses the one that matches their immediate and long-term career goals.
So, if you are interested in pursuing a certification in medical billing and coding, here are some of the recognized certifications you can choose from.
Types of Medical Billing and Coding Certifications
Table of Content
- Certified Professional Coder-Player (CPC-P)
- Certified Coding Assistant (CCA)
- Certified Coding Specialist (CCS)
- Certified Coding Specialist – Physician-based (CCS-P)
- Certified Professional Coder-Hospital (CPC-H)
- Certified Professional Coder-Payer (CPC-P)
- Certified Billing and Coding Specialist (CBCS)
- Certified Professional Biller (CPB)
- Certified Professional Coder (CPC)
- Certified Outpatient Coding (COC)
- Certified Inpatient Coder (CIC)
- Certified Risk Adjustment Coder (CRC)
- The American Academy of Professional Coders (AAPC)
- The American Health Information Management Association (AHIMA)
- Which is the Best Medical Billing and Coding Certification?
Certified Professional Coder-Player (CPC-P)
This AAPC certification demonstrates a coder’s proficiency and knowledge of coding guidelines and reimbursement methodologies for services from the payer’s perspective. It verifies their ability to adjudicate provider claims effectively. To get this certification, you have to be a member of AAPC and pass the CPC-P exam.
Certified Coding Assistant (CCA)
This certification is offered by the American Health Information Management Association (AHIMA). The CCA designation is the entry-level certification offered by the AHIMA and demonstrates their competency across all settings, including both hospitals and physician practices.
The AHIMA recommends that aspiring CCAs have six months of direct coding experience or have completed an AHIMA-approved coding program or have completed another training program that includes medical terminology, basic CPT coding and anatomy and physiology.
The CCA exam consists of 100 multiple-choice questions and tests the candidate’s knowledge of reimbursement methodologies, classification systems and other essential areas of coding.
Certified Coding Specialist (CCS)
This AHIMA certification verifies the candidate’s skill in classifying medical data from patient records, usually in a hospital setting. CCS coding professionals are knowledgeable in pharmacology, disease processes and medical terminology.
To qualify, candidates must have two years of related coding experience where they directly apply codes or have a CCA plus one year of experience or have completed the following courses: pathophysiology, pharmacology, medical terminology, reimbursement methodology and anatomy and physiology.
They could also qualify for the CCS by holding the RHIA, RHIT or CCS-P credential. The exam consists of 97 multiple-choice questions and eight medical scenarios, each with up to three separate questions. Candidates are given a total time of four hours to complete.
Certified Coding Specialist – Physician-based (CCS-P)
Through this AHIMA certification, coding professionals verify their specialization in physician-based settings like doctor’s offices, group practices, specialty centers and multi-specialty clinics. The same qualifications apply for this Physician-base CCS certification that applies for the CCS certification. Also like the CCS certification, the exam has 97 multi-choice answers and eight scenarios with up to three questions for each. The total texting time for this exam is four hours.
Certified Professional Coder-Hospital (CPC-H)
This is a specialized certification offered by the AAPC. Candidates must have at least two years experience of coding and maintain their yearly renewal. To obtain this certification, they must complete an examination that consists of questions about the correct application of CPT, ICD-10-CM diagnoses and procedure codes for billing facility services.
Certified Professional Coder-Payer (CPC-P)
This AAPC certification verifies that candidates have the knowledge to adjudicate claims effectively, and demonstrate their knowledge and skills within the payer environment. To qualify, candidates must have at least two years of coding experience working with HCPCS, CPT or ICD-10-CM.
Certified Billing and Coding Specialist (CBCS)
Offered by the National Healthcareer Association (NHA), this exam verifies that candidates have the skill to support the coding and billing process, assign codes for diagnoses and procedures, prevent fraud by auditing billing and submit claims for reimbursement.
Certified Professional Biller (CPB)
This certification, offered by AAPC, prepares medical billers with the skills they need to maintain all aspects of the revenue cycle. The CPB verifies that medical billers have an understanding of various types of insurance plans, experience in applying payer policy, Local Coverage Determinations (LCDs) and National Coverage Determinations (NCDs).
It also shows they understand how to successfully navigate the complex rules and regulations of the healthcare industry. This exam consists of 200 multiple-choice questions that take five hours and 40 minutes to finish.
Certified Professional Coder (CPC)
Offered by the American Association of Professional Coders (AAPC), the CPC certification is the most popular certification in this field. The AAPC recommends that anyone interested in pursuing this certification obtain an associate’s degree in medical billing and coding.
Candidates can also train with AAPC by enrolling in the CPC Preparation Course. This certification covers multiple aspects of the profession, including procedure codes for other a dozen fields, medical terminology, coding guidelines and diagnostic codes.
Certified Outpatient Coding (COC)
Also offered by the AAPC, this certification shows that candidates are proficient in assigning medical codes for procedures and services performed in outpatient settings and outpatient therapies. AAPC recommends an associate’s degree for this certification and that the candidate has at least two years of medical coding experience. The exam consists of 150 multiple-choice questions and allows candidates five hours and 40 minutes to complete.
Certified Inpatient Coder (CIC)
Candidates with this certification have verified expertise in assigning accurate medical codes for diagnoses and procedures performed in an inpatient setting. It also shows that they have superior knowledge of the rules and regulations for medical coding and compliance. This exam, offered by the AAPC, consists of 60 multiple-choice questions as well as 10 inpatient cases with fill-in-the-blank responses. Candidates are allowed five hours and 40 minutes to finish.
Certified Risk Adjustment Coder (CRC)
Medical coders with this AAPC certification have proven that they understand how to review and assign accurate medical codes for diagnoses performed by physicians and other qualified healthcare providers in the office or facility setting.
They have also proven that they understand the audit process for risk adjustment models and the anatomy, pathophysiology and medical terminology necessary to code diagnoses. The exam consists of 150 multiple-choice questions and candidates are given five hours and 40 minutes to complete.
Medical Billing and Coding Certifying Bodies
There are two major medical billing and coding certifying bodies in the United States and perhaps on a global level and they are;
The American Academy of Professional Coders (AAPC)
The American Academy of Professional Coders (AAPC) offers several certifications in coding and billing specialties, including the Certified Professional Coder (CPC) designation. This certification is widely recognized in physician’s office settings, and proves a specialist’s knowledge and experience with medical coding. Other certifications specialize in areas such as in-patient and out-patient coding procedures, and risk adjustment.
The American Health Information Management Association (AHIMA)
The American Health Information Management Association (AHIMA) also offers various credentials that demonstrate coding proficiency. The Certified Coding Associate (CCA) designation is awarded to individuals qualified to work across settings, including hospitals and private practices, while other certifications are offered to those who specialize in one setting.
Which is the Best Medical Billing and Coding Certification?
Choosing the best medical billing and coding certification is not straightforward because each of the certifications have their key areas of specialization that can suit professionals who want to practice in that niche area. For example, a medical billing and coding professional who wants to build a career as a risk adjuster in the medical field needs to pursue the Certified Risk Adjustment Coder (CRC) certification.
So also, if you want to specialize as an inpatient medical billing and coding professional, then you should pursue the Certified Inpatient Coder (CIC) certification. But if you want to specialize as an outpatient medical billing and coding professional, then you should pursue the Certified Outpatient Coding (COC) certification.
Over and above, if you want to build a profession in the medical billing and coding services industry, then any of the above listed certifications is ideal for you.