Wednesday, June 13, 2012

Medical Billing and Coding Certification

Professional medical billing and coding certification is a designation earned by an individual as proof that a minimum level of competency. Certification typically follows graduation from a formal training program and requires passing a certification exam. The certification is usually earned from a professional society and valid for a defined time, such as 1 year. These certifications must be renewed on a periodic basis and require evidence of completion of continuing education units (CEU’s) and maintaining membership in the granting professional society.

Certification is different from being licensed. Licensing is typically required by state government agencies to demonstrate a minimum level of knowledge or ability as required by law.

Benefits of Certification:

  • Distinguishes you from others - gives you an advantage when applying for job over those not certified.
  • Shows your commitment to the profession - Shows management that you are improving.
  • Improves income potential.
  • Demonstrates a basic level of knowledge about the profession.
  • Commitment to ethical responsibilities of the profession.
  • Improved opportunities for advancement.

There's not a combined medical billing and coding certification, but there are separate certifications for medical billing and medical coding. Medical coding certifications are more diverse and involved due to the complexity of coding. Independent home based medical coders and billers benefit from certification for marketing your credentials to potential clients.

Medical Billing Certification

The American Medical Billing Association (AMBA) is probably one of the most recognized organizations offering a medical billing certificate through examination and education. The Certified Medical Reimbursement Specialist (CMRS) is an exam based certification that demonstrates a knowledge in insurance reimbursement, medical terms, coding (ICD9, CPT4 and HCPCS), claim appeals, and compliance (HIPAA and OIG). The CMRS exam has 16 sections with 700 questions. A score of 85% is required to pass and recieve the CMRS credential designation.

The CMRS Exam is divided into 16 Sections:

  • Medical Terminology
  • Anatomy and Physiology
  • Information Technology
  • Web and Information Technology
  • ICD-9-CM Coding
  • CPT-4 Coding
  • Clearinghouses
  • CMS 1500
  • Insurance
  • Insurance Carriers
  • Acronyms
  • Compliance
  • Fraud and Abuse
  • Managed Care
  • General
  • Case Study

Maintaining certification requires obtaining 15 continuing education units (CEU’s) from an approved listing every year. Cost is $325 plus membership in AMBA. AMBA recognizes the CEU’s from courses offered by the AAPC (American Academy of Professional Coders) and many other reputable organizations.

Healthcare Billing and Management Association

The Healthcare Billing and Management Association offers the Certified Healthcare Billing & Management Executive (CHBME) and Certified Medical Billing Associate (CMBA). However these tend to be designed more for executives, managers, and supervisors. Probably the highest level of credentialing offered for medical billing andreimbursement is the RHIA and RHIT certifications offered by the AHIMA (American Health Information Management Association).

RHIA is Registered Health Information Administrator. They are mostly involved with the management of patient health information, medical records, and computer information systems.RHIT is Registered Health Information Technician. They are health information technicians associated with medical records and computer applications and systems.

Medical Coding Certification

Coding credentials are administered by two different organizations - AAPC (American Academy of Professional Coders) and the AHIMA (American Health Information Management Association). Employers may have differing preferences when hiring. If you are considering becoming credentialed talk with an experienced professional already in the coding field and get their opinion.

Here's a summary of their certifications:

AAPC Certifications:

  • CPC - Certified Professional Coder
  • CPC-H - Certified Coding Specialist - Hospital
  • CPC-P - Certified Coding Specialist - Payer
  • AAPC also offers several other specialty credentials

AHIMA Certifications:

  • CCA - Certified Coding Associate. This is an entry-level certification.
  • CCS - Certified Coding Specialist. More proficient coders.
  • CCS-P - Certified Coding Specialist - More proficient Physician Based coder.
  • CHDA - Certified Health Data Analyst


  1. Thanks for letting me know how to acquire medical billing and coding certification.

  2. Healthcare institutions or other individual’s physicians will Hire Medical Coding Services who one can improves the business run from bottom line. These services firms take the necessary expertise steps to satisfy the business commitment of doctors.

  3. Nice post. Thanks for your valuable information. Specific Offshore billing company would have expertise and certified billers in the area of healthcare informatics to provide value added solutions to clients in case of improving healthcare organizations income potential.