What Is a Billing and Coding Certification? (With 11 Certification Options)
Updated April 3, 2023
A billing and coding certification can be a useful way to increase your competitiveness in the job market for billing and coding specialists. This certification verifies that you have the skills and knowledge to perform this job successfully. Learning more about this certification and exploring the options available to you can help you become more prepared for a career in billing and coding.
In this article, we explain what a billing and coding certification is, list its benefits and explore 11 different billing and coding certifications that you may want to consider.
What is a billing and coding certification?
A billing and coding certification is a professional credential that recognizes billing and coding specialists and helps them showcase their expertise to employers. A billing and coding specialist processes medical bills, insurance claims and payments.
They create coded data that hospitals and medical providers use to obtain reimbursement from insurance companies or government programs. Medical billers then use that coded information to prepare and send invoices to patients and insurance providers.
Both foundational billing and coding certifications and specialty certifications require examinations and formal training. Most states require medical billers and coders to have at least one active certification. Having multiple certifications may give you an advantage when applying for jobs.
Requirements to earn a billing and coding certification
While the specific requirements to earn this certification typically vary based on the certifying agency or company, there are a few common requirements, including:
Education: To work in any medical field, prior education is often necessary. Many certification programs require or prefer that you complete your online medical billing and coding education and have a college degree from an accredited university, such as an associate degree.
Experience: Many certification programs also require that you have prior employment experience working in the billing and coding field. This experience can demonstrate that you already understand the basics of the field and its requirements.
Examination: Certifying bodies typically require that you pass one or more examinations before you can earn your certification. The length of time the exam takes to complete and the number of questions on it typically varies depending on the organization.
Benefits of earning a certification in billing and coding
There are many benefits to earning this certification, including:
Greater career advancement: Certain certifications may help you advance your career more quickly, allowing you to qualify for higher-paying positions that offer more opportunities to display your leadership skills.
Networking opportunities: While completing a certification program, you may have the opportunity to network with other aspiring billing and coding specialists and individuals who already have extensive experience in their specialty.
Flexible options: There are numerous certifications available to billing and closing specialists, meaning you can choose one that best matches your career interests and scheduling needs.
11 billing and coding certifications
Here are 11 billing and coding certifications that may benefit your career. Please note that none of the companies mentioned in this article are affiliated with Indeed.
Offered by the National Healthcareer Association (NHA), this certification verifies that you have the skills required to support the coding and billing process, assign codes for diagnoses and procedures, prevent fraud by auditing billing procedures and submit claims for reimbursement.
The CBCS is ideal for entry-level medical coding and billing specialists. To earn the certification, you need a high school diploma or equivalent, along with either the completion of a medical billing and coding training or education program within the last five years or one year of supervised work experience within the last three years.
The NHA also requires candidates to complete a three-hour exam that comprises 100 scored questions. The exam's topics include regulatory compliance, claims processing, front-end duties, payment adjudication and applied coding knowledge. You can study for it using the NHA's resources. Certification renewal requires 10 continuing education units (CEUs) and a recertification fee every two years.
This certification is available through the American Health Information Management Association (AHIMA), and it's beneficial for entry-level coders working in hospital and physician office settings. It's a nationally recognized standard of achievement in the health information management (HIM) field. You need a minimum of a high school diploma or equivalent to qualify.
The AHIMA also requires that you complete an AHIMA-approved coding program and a program that includes topics related to anatomy and physiology, medical terminology, basic International Classification of Diseases (ICD) concepts and Current Procedural Terminology (CPT) coding.
The computer-based exam has 115 total test items, and to pass, you need a minimum score of 300. You have two hours to complete the test, which addresses reimbursement methodologies, classification systems and other essential areas of coding. Codebooks are mandatory for the test. You can prepare by reviewing questions online. Certification renewal involves completing 20 CEUs every two years and paying the recertification fee.
This certification is also available through the AHIMA, and it verifies a candidate's skills in classifying medical data from patient records in a hospital setting. This certification is ideal for mid-level billing and coding specialists.
To qualify for the CCS, you must complete courses in anatomy and physiology, pathophysiology, pharmacology, medical terminology, reimbursement methodology, intermediate and advanced ICD diagnostic coding, procedural coding and medical services. You also need two years of medical coding experience, an active coding credential with a year of experience or the CCA certification with a year of experience.
The computer-based exam has a multiple-choice section and a medical scenario section. Candidates have a total time of four hours to complete it. The AHIMA requires candidates to bring a current codebook to the test center. A total of 20 CEU hours and a recertification fee are required every two years. The AHIMA also has an optional test prep course to help you prepare for the exam.
The CCS-P certification verifies coding specialization in physician-based settings like doctor's offices, group practices, specialty centers and multispecialty clinics. This certification is available through the AHIMA, and it's beneficial for billing and coding personnel with extensive experience in the field.
Candidates must complete a medical coding training program that offers the same coursework as the CCS. Alternatively, you need at least two years of medical coding experience, the CCA credential with at least a year of experience, another credential with a year of experience or an active CCS.
The computer-based exam has 97 to 121 total items, including multiple-choice and medical scenario questions that test knowledge, skills and experience in medical billing. Candidates have four hours to complete it, and a current codebook is necessary. Like other AHIMA exams, a passing score of 300 is necessary to obtain the credential.
5. Certified Inpatient Coder (CIC)
Candidates with this certification have verified expertise in assigning medical codes for diagnoses and procedures performed in an inpatient setting. This certification shows you know how to handle ICD-10 Procedure Coding System (PCS) and the ICD-10 Clinical Modification (CM).
The American Academy of Professional Coders (AAPC) offers this high-level certification, addressing hospital and facility inpatient coding topics. To qualify, the AAPC prefers that you have an associate degree and be a current AAPC member.
The AAPC allows candidates four hours to complete the exam, containing 40 multiple-choice questions and seven fill-in-the-blank inpatient cases. You must understand the correct application of ICD-PCS procedure codes and ICD-10-CM diagnosis codes and bring your own codebook to the exam.
You need a score of at least 70% or higher to pass. The AAPC allows at least one retake. Renewal requires annual AAPC membership and the completion of 36 CEUs every two years.
The CMC certification recognizes individuals with advanced training in medical coding guidelines for outpatient claims, and it's available through the Practice Management Institute (PMI).
The PMI's prerequisites include at least one year of experience in outpatient medical coding or the completion of foundational training courses. Before applying, it's necessary to complete the PMI medical coding assessment to identify potential knowledge gaps before training.
After completing the assessment, you can apply to take the exam. The PMI offers candidates six hours to review questions, study codebooks and provide responses. A score of at least 70% is necessary to pass that exam. To retain the credential, completing 12 hours of continuing education each year is necessary.
The AAPC also offers the COC certification, which shows a coder's proficiency in assigning medical codes for procedures and services performed in outpatient hospital groups, outpatient surgical centers and hospital billing and coding departments. The prerequisites include two years of medical coding experience and an active AAPC membership.
To earn the credential, you need a score of at least 70% on the 100-question, multiple-choice exam. The AAPC provides candidates with four hours to complete the exam. Renewal requires annual AAPC membership and the completion of 36 CEUs every two years.
This certification, offered by the AAPC, verifies that an experienced medical biller has the skills to manage all aspects of the revenue cycle. It ensures they thoroughly understand the various types of insurance plans and possess the experience to apply payer policies, local coverage determinations (LCDs) and national coverage determinations (NCDs). The AAPC recommends earning an associate degree and requires an existing AAPC membership to apply.
This exam has 135 multiple-choice questions, allowing test takers four hours to complete. A passing score of at least 70% allows you to qualify for the certification. Renewal requires annual AAPC membership and 36 CEUs every two years.
Offered by the AAPC, the CPC certification addresses multiple aspects of the medical coding profession, including procedure codes for coding and billing for medical claims in a physician's office. The prerequisites include at least two years of experience in the medical coding field and current AAPC membership. An associate degree in medical billing and coding can also be helpful.
The CPC exam has 100 multiple-choice questions. Topics include ICD-10-CM, Health care Common Procedure Coding System (HCPCS), medical terminology, anesthesia, radiology, pathology, evaluation and management. Individuals without experience may prefer to earn the Certified Professional Coder-Apprentice (CPC-A) version instead. At least 36 hours of CEUs are required every two years for certification renewal.
Related: How To Write a Medical Coding Resume
The CPMA certification available through the AAPC demonstrates that a person knows coding and documentation guidelines that are necessary to improve the revenue cycle and health care practices. It verifies that they understand the risks associated with noncompliance.
People with a CPMA demonstrate expertise in coding concepts, medical documentation, fraud and abuse and coding risk analysis. Annual AAPC membership is necessary to qualify, and the organization recommends at least two years of experience in medical auditing.
The proctored exam has 100 multiple-choice questions, and candidates have four hours to complete it. This certification is ideal for individuals with extensive auditing experience and medical coding knowledge. At least 36 hours of CEUs are required every two years for certification renewal.
The CRC certification offered by the AAPC verifies proficiency in assessing patient risk scores for improved patient outcomes and in reviewing and assigning accurate medical codes for diagnoses performed by physicians and other qualified health care providers in an office or facility setting. It also shows a coder's understanding of the audit process for risk adjustment models and the anatomy, pathophysiology and medical terminology necessary to code diagnoses. The primary prerequisite is AAPC membership.
The exam contains 100 multiple-choice questions, and candidates have four hours to complete it. Like other AAPC exams, a passing score of 70% is necessary to earn the certification. At least 36 hours of CEUs are required every two years for certification renewal. This certification is ideal for billing and coding personnel with extensive field experience.
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