Medical billing and coding is a growing field with plenty of opportunities for those looking to start a career in healthcare. Medical billers and coders play a vital role in the healthcare system by translating medical procedures and diagnoses into universal codes that are used for billing purposes. This helps ensure healthcare providers are properly reimbursed for the services they provide.
To become a medical biller and coder, some type of certification is usually required or preferred by employers. There are a few major organizations that offer certifications in this field. Deciding which certification is best depends on your education level, work experience, the types of jobs you’re interested in, and other factors.
What are the requirements for medical billing and coding certifications?
The requirements for earning a certification in medical billing and coding vary depending on the specific certification. Here are some of the common requirements:
– High school diploma or equivalent
– Completion of a medical billing and coding training program or coursework
– No experience required for entry-level certifications
– 1-2 years of work experience may be required for advanced certifications
– Passing a certification exam administered by the certifying body
Some employers and certification programs may require or prefer candidates to have an associate’s or bachelor’s degree as well. Coursework in anatomy, physiology, medical terminology, coding, insurance, and computer skills is also helpful.
What are the main organizations offering certifications?
There are three major organizations that offer accredited certifications for medical billing and coding:
American Health Information Management Association (AHIMA)
AHIMA offers two main certifications:
– Certified Coding Associate (CCA) – entry-level
– Certified Coding Specialist (CCS) – mid-level
American Academy of Professional Coders (AAPC)
AAPC offers four main certifications:
– Certified Professional Coder (CPC) – entry-level
– Certified Professional Coder – Apprentice (CPC-A) – entry-level apprentice
– Certified Professional Coder – Hospital (CPC-H) – inpatient hospital coding
– Certified Professional Coder – Payer (CPC-P) – insurance billing
National Healthcareer Association (NHA)
NHA offers two main certifications:
– Certified Billing and Coding Specialist (CBCS) – entry-level
– Certified Coding Associate (CCA) – AHIMA administered exam
What is the difference between the AHIMA and AAPC certifications?
The main differences between the AHIMA and AAPC certifications include:
Exam Focus
– AHIMA certifications focus on medical documentation, coding systems, and standards.
– AAPC certifications focus on coding and billing procedures and guidelines.
Certification Levels
– AHIMA offers an entry level (CCA) and a mid-level certification (CCS).
– AAPC offers multiple entry level and specialist certifications.
Recertification Requirements
– AHIMA requires ongoing education credits to maintain certification.
– AAPC requires passing a new exam every 2 years to maintain certification.
Recognition
– AHIMA certifications are more widely recognized and required for some roles.
– AAPC certifications are more common among independent coders and consultants.
So in summary, AHIMA is more academic and hospital focused while AAPC is more hands-on and physician office focused. Many coders get certified through both organizations.
What is the best entry-level medical billing and coding certification?
For those new to the medical billing and coding field, an entry-level certification is the place to start. This allows you to get your foot in the door without needing previous coding experience.
Based on the prestige, recognition, and exam focus, the following are considered the best entry-level certifications:
AHIMA Certified Coding Associate (CCA)
The CCA demonstrates basic competency in medical coding and is often the minimum requirement for coding jobs. The exam covers medical terminology, coding systems, reimbursement methodologies, and health records. It’s a great starter certification before moving onto more advanced AHIMA or AAPC certifications.
AAPC Certified Professional Coder (CPC)
The CPC focuses heavily on proper coding techniques and guidelines. The exam covers coding for all the major medical specialties as well as ethics, medical terminology, and reimbursement guidelines. The CPC is very practical focused and great for outpatient or physician-based coding roles.
AAPC Certified Professional Coder – Apprentice (CPC-A)
The CPC Apprentice certification has the same exam topics and difficulty as the CPC. However, the CPC-A allows an apprentice-level coder to take the exam before they have any experience. Once the coder gains practical coding experience, they can upgrade to the full CPC credential.
So for those just starting out, the CCA, CPC, and CPC-A are the top recommended certifications. They provide a solid foundation of coding and billing knowledge. Many coders start with one and work towards earning the other certifications later on.
What is the best advanced medical billing and coding certification?
For medical coders who already have at least 2 years of on-the-job coding experience, an advanced certification can help take their career to the next level. They demonstrate specialized expertise in a particular area of coding and billing.
Here are some of the top advanced certifications for experienced coders:
AHIMA Certified Coding Specialist (CCS)
The CCScertification demonstrates mastery-level knowledge of ICD diagnostic and CPT procedural coding. Earning the advanced CCS credential after the CCA helps coders specialize and move up into senior coding roles.
AAPC Certified Professional Coder – Hospital (CPC-H)
The CPC-H credential focuses specifically on inpatient hospital coding which requires specialized skills and knowledge. Having both the CPC and CPC-H makes coders highly versatile for different healthcare settings.
AAPC Certified Professional Medical Auditor (CPMA)
The CPMA certification covers provider billing documentation auditing and compliance. It teaches the principles needed for auditing, compliance, and risk management roles.
AAPC Certified Professional Coder – Payer (CPC-P)
The CPC-P focuses on coding for the commercial payers and Medicare/Medicaid claims. The exam covers insurance requirements, coverage rules, payment methods, and reimbursement guidelines.
So for experienced coders looking to advance their career, the CCS, CPC-H, CPMA, and CPC-P certifications allow them to specialize and open up more senior-level job opportunities.
Should you earn multiple medical billing and coding certifications?
Here are some of the benefits of earning multiple medical billing and coding certifications:
– Increased knowledge across different coding specialties – Build expertise in inpatient, outpatient, and diagnostic coding for broader job qualification.
– Flexibility to work in multiple healthcare settings – Certifications like the CCS and CPC-H allow mobility between physician, hospital, and clinic work environments.
– Demonstrated commitment to the profession – Multiple certifications show motivation to keep skills sharp through ongoing education and training.
– More promotion and job opportunities – Additional certifications provide advancement opportunities to lead or auditor roles and higher salaries.
– Recertification requirements may be reduced through CEUs – Some certifications offer extensions on their recertification deadlines when other certifications are held.
The more education, training, and certifications a medical coder has, the more they can advance their career and salary over time. Starting out with an entry-level certification then working towards an advanced certification creates a strong foundation and growth path over the long-term.
Which medical billing and coding certification is right for me?
Choosing the right certification depends on several factors related to your goals and current professional status:
– Experience level – Are you an entry level or experienced coder? Choose basic or advanced certifications accordingly.
– Work setting – Do you want to work in a hospital, physician practice, or specialty clinic? Certain certifications like the CPC and CPC-H are focused for specific settings.
– Specialization – Areas like auditing, compliance, or insurance require targeted certifications like the CPMA or CPC-P.
– Education – Do you have a degree that qualifies you for more advanced certifications right away?
– Career goals – Where do you want to be in 5 years? Certifications like the CCS allow upward mobility in management roles.
– Budget – Entry certifications range from $300 to $400 for self-study materials and exam fees. Advanced certifications cost $400 to $500+.
Take stock of your education, experience, work environment, and career goals. Look for certifications that match your status and aspirations. An incremental approach over time can give you flexibility.
Conclusion
Earning the right medical billing and coding certification provides a big boost for your career. While there are many options, the CCA, CPC, CCS, and other credentials from AHIMA and AAPC provide the greatest prestige and opportunity.
A combination of certifications helps coders gain expertise across different healthcare settings and professional levels. Starting with an entry level certification then working up to advanced certifications shows dedication and helps maximize job mobility. Multiple certifications can lead to increased salary, job scope, and management opportunities.