Medical Billing and Certifications

The medical billing occupation remains largely unregulated in the United States of America (USA). Usually it is the doctors/employer who set their own rules and standards when they hire; they decide whether they want a medical biller that is fresh out of school, or certified, has a degree, or a certain amount of job experience. Larger facilities need medical billers who can handle a broader spectrum of situations and more complex cases.

Medical Coding Certification

Medical billing and/or medical coding certification in the USA remains voluntary. No local, state or federal law mandates that those doing medical billing and medical coding must be certified, however, those who took a recognized certification exam have now achieved instant credibility with their employer and future employers by proving that

a.) they are serious and knowledgeable professionals
b.) they are willing to "invest" into their career path and outcome
c.) they are determined to stand above the rest

Certification exams are held at different intervals, often annually, semi-, or tri-annually at designated testing sites for individuals who meet the training and experience requirement as determined by the sponsoring organization.

"Our" Steve, our (volunteer!) Medical Billing Community forum administrator, has mentioned Professional Association of Healthcare Coding Specialists (PAHCS), a local organization in Tampa, FL and the Certified Medical Billing Specialists (CMBS) as respected certification sponsors a in the forum. He also mentioned RHIT and CPC once or twice. I know the National Healthcareer Association (NHA) offers their Certified Billing & Coding Specialist (CBCS) exam, which is accredited by the National Commission for Certifying Agencies (NCCA).

Choosing a Certification Provider

There are many professional membership and certification providers; some offer a broad, general credential, other offer specialized certifications in specific areas. These organizations include the American Health Information Management Association and the American Academy of Professional Coders. Coding for specialist medical fields is offered by the Professional Association of Healthcare Coding Specialists and the National Cancer Registrars Association.

Here are some pointers and questions you can ask when contacting an organization:

1. Recognition... national, local, e.g. which credentials are employers asking for (preferred) in the area
2. Cost... registration fees for the exam, annual membership fees, re-certification cost (how often?)
3. Testing... when are the exam dates, and how and where are they held (convenient, written, online?)
4. Recertification... how long before I have to retest (the longer it is valid, the less stress and cost)
5. Membership support... e.g. insurance discounts, workshops, magazines, toll-free help line, forum
6. Continuing education... requirements, cost, access to CEU, can I use CEU from other sources
7. Workshops and chapter meetings, in my area, free and CEU credits?

Medical billing and coding certification and professional membership organizations strive to build close relationships with accredited vocational training institutions. This creates a win-win situation for everybody, the school, their faculty and their medical assistant students because they PREFER schools with programs that lead to recognized certifications. In return the schools achieves better student recruitment, retention and placement.

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