Medical Billing and Coding Certifications: Which One Should You Get?
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Whether you're just starting your medical billing and coding career or hoping to specialize, it can be challenging to choose the proper certification.
This guide will cover all the certifications offered by the leading medical billing and coding certifying organizations: AAPC, American Health Information Management Association (AHIMA) and National Healthcareer Association (NHA). Understanding what each certification signifies and how much it costs will help you decide whether to pursue it.
Certifying Organizations
Medical billing and coding professionals must pass a test to earn a certification. These tests are administered by professional organizations, the two most prominent of which are AAPC and AHIMA. Many employers also recognize NHA's certification.
AAPC
AAPC is the nation’s most extensive education and credentialing organization for medical coders and other healthcare professionals. It was founded in 1988 to provide education and certification to coders working in physician-based settings. The organization was established as the American Academy of Professional Coders but now goes by AAPC as it has expanded its services beyond medical and outpatient coding.
AHIMA
The American Health Information Management Association (AHIMA) was founded in 1928 to improve health record quality. It has played a significant role in managing medical records and data and offers multiple certifications for medical billing and coding professionals. AHIMA certifications emphasize the practical skills needed in maintaining healthcare records.
NHA
The National Healthcareer Association (NHA) is the country's largest allied health certification agency, awarding over one million certifications in eight different areas. The NHA also promotes the value of certification with legislative and regulatory bodies to bring positive change to the healthcare industry.
Entry-Level Certifications
After completing a medical coding or billing training program, students typically sit for one (or more) of the following exams.
CPC
The AAPC offers the Certified Professional Coder (CPC) certification, the gold standard for medical coding in physicians’ offices. It focuses on coding for services performed by doctors, physician assistants, and nurse practitioners. The exam features 100 multiple-choice questions, and test takers have four hours to complete the exam. It tests the understanding of the proper application of the Common Procedure Coding System, Healthcare Common Procedure Coding System (HCPCS) Level II procedure and supply codes, and ICD-10 codes. To maintain this credential, you must keep an annual AAPC membership and complete 36 continuing education units every two years.
CPB
Another certification the AAPC offers is the Certified Professional Biller (CPB) credential. This medical coder certification focuses on all aspects of revenue cycle management, emphasizing patient and payer billing and collections. The exam covers most of the content in the CPC exam and how to submit claims that comply with private-payer policies and government regulations. It requires knowledge of medical terminology, current procedural terminology, pathophysiology, and anatomy and understanding compliance rules, payer policies, and healthcare regulations. In their careers, people with this certification follow up on claim statuses, submit appeals, resolve claim denials, manage collections, and post payments and adjustments. The exam is 135 multiple-choice questions in four hours. An annual membership with the AAPC and 36 continuing education units every two years are required to maintain the certification.
CBCS
The NHA offers the Certified Billing and Coding Specialist (CBCS) certification. This exam covers many vital functions of the role, including gathering and reviewing essential information, preventing fraud or abuse by auditing billing, coaching healthcare providers to achieve optimal reimbursement, assigning codes for diagnoses and procedures, and submitting claims for reimbursement. This certification is renewed every two years; it requires only ten continuing education units to do so.
CCS
AHIMA offers the Certified Coding Specialist (CPC) and focuses on coding both in-patient and out-patient records. Those taking the exam must be well-versed in the ICD-10-CM, ICD-10-PCS, and CPT coding systems and have expertise in medical terminology, current procedural terminology, disease processes, and pharmacology concepts. The exam takes four hours to complete and is 107 questions long. In addition to a multiple-choice section, this exam also features a medical scenario section that contains multiple-choice, multiple-response questions that focus on scenarios in outpatient, inpatient, and emergency room scenarios.
Looking for an online medical billing and coding program? Check out tour roundup of top programs.
Specialized Certifications
Specialty certifications are available for professionals with significant expertise in a specific medical area. These certifications are optional, but they provide a promising opportunity for specialization. Exams for these certifications are more focused and designed to create real-life scenarios that test how professionals use their coding skills and knowledge.
When and why to consider another certification
Specialty certifications can open doors to a variety of opportunities. On average, medical coders with a specialty certification earn more than those without. For example, the AAPC estimates that a CBC makes about $56,981 yearly, while a Certified Professional Compliance Officer (CPCO) may make $81,495.
If you have expertise in a specific field and want to advance your career, consider taking one of the following national certification exams.