Licenses and Certifications Your Medical Biller and Coders Should Have

Having a competent and high-performing team of medical billers and coders is an important aspect in running your healthcare business smoothly and successfully as both are crucial to revenue cycle management. Medical billers submit and follow up claims with insurance companies to receive payment for services rendered by a healthcare provider while medical coders translate medical reports like diagnoses, medications, and procedures into codes that are used by insurance companies to reimburse the provider.

Medical billers and coders should be equipped with the adequate skills and knowledge needed in their fields including understanding how to read medical records and being familiar with the three key code sets among others to be more efficient with their responsibilities that are crucial to the financial resources of medical organizations. One way to ensure the credibility of your billers and coders is to hire those who are not just highly skilled but are certified by accredited organizations.

To help you out, here are different kind of certifications granted to medical billers and coders and the organizations that grant them:

Billing certification (Medical Billers)

American Academy of Professional Coders

Medical billers can earn their Certified Professional Biller (CPB) credential from the American Academy of Professional Coders (AAPC). According to AAPC, this certification guarantees that a biller has an understanding of various types of insurance plans, expertise in applying payer policy, Local Coverage Determinations (LCDs), and National Coverage Determinations (NCDs) for successful claim submissions; knowledge of CPT, ICD-10-CM, and HCPCS Level II coding guidelines; successful navigation of healthcare industry rules and regulations; an understanding of the life cycle of a medical billing claim and how to improve the revenue cycle; and expertise in effective claim follow-up, patient follow-up, and denial resolution.

American Medical Billing Association

The American Medical Billing Association (AMBA) offers their Certified Medical Reimbursement Specialist (CMRS) Exam, the longest standing and most thorough exam for professional medical billers. Those who pass the exam and qualify for the certification are recognized as competent and proficient in the field, and are committed to promote ethical and professional medical billing.

Coding certification

American Academy of Professional Coders (AAPC)

AAPC’s certifications for medical coders are nationally recognized and deemed as the gold standard in the healthcare industry. They offer multiple types of certifications for all levels of experience and types of specialties:

●        Certified Professional Coder (CPC) and Certified Outpatient Coding (COC) certification holders from AAPC have a proficiency in the correct application of CPT®, HCPCS Level II procedure and supply codes, and ICD-10-CM diagnosis codes used for coding and billing in a physician’s office and in an outpatient hospital or facility, respectively.

●        Certified Inpatient Coder (CIC) and Certified Risk Adjustment Coder (CRC) certification holders, on the other hand, have extensive knowledge in the correct application of ICD-10-CM diagnosis codes used for coding and billing for medical claims in an inpatient hospital or facility and used in risk adjustment payment models, respectively.

●        The Specialty Coding Certification is given to expert coders to demonstrate superior levels of expertise in their respective specialty disciplines. AAPC is currently offering over 15 types of specialty certifications.

American Health Information Management Association

The Certified Coding Associate (CCA) certification granted by the American Health Information Management Association (AHIMA) signifies that the holder possesses coding competency across all settings, including hospitals and physician practices and commitment to the profession. To be eligible to take the CCA exam, candidates must at least have a high school diploma. Having experience in coding or completing a coding training program is also recommended but not required.

Board of Medical Specialty Coding and Compliance

For experienced medical coders, clinicians and compliance professionals, the Board of Medical Specialty Coding and Compliance (BMSC) is the provider of specialty medical coding certification, education and training for them as part of its advocacy of creating a career ladder for medical professionals through multiple layers of coding and compliance education. As of the moment, testing for new candidates is not available and BMSC only allow recertification of the following:

●        Specialty Coding Professional (SCP)

●        Advanced Coding Specialist (ACS)

●        Certified Compliance Professional – Physician (CCP-P)

While having a certification is not a requirement to be a medical biller or coder, it is still a valuable credential that can help them stand out in a pool of applicants. Holding a certification shows that one has an extensive knowledge and tangible experience in the said fields. Certified billers and coders also have an edge over their non certified colleagues when it comes to staying up-to-date on regulatory changes that affect their practice. This is because they have to  complete a specified number of continuing education units every two years after being awarded with their certificate to maintain the validity of certification.

If you’re looking to hire certified and trained medical billers and coders, your best option is to outsource from a reputable company with access to trained professionals. Outsourcing can solve the common problems that arise during the hiring process including the shortage of qualified candidates and shouldering expensive training and recertification.

A trusted healthcare outsourcing partner who can help you build a great  RCM team such as certified medical billers and coders assures you an accurate deal with medical bills and claims as well as the resources to handle your claims quickly, with minimal denials, minimizing turnaround time while optimizing reimbursement. When it comes to healthcare, finding the right outsourcing partner can assist you whether they be growth, better productivity or simply bottom-line cost savings of up to 70%. ISO-certified, HIPAA- and GDPR-compliant are also crucial things to consider for a great partnership to secure your company and patient’s data.

Partnership with Infinit-O

Infinit-O’s mission is to create endless opportunities for your company to realize your full potential.

Below are some of the experts we can gather for the unique RCM and healthcare needs:

• Medical Coders
• Medical Billers
• Clinical Abstractors
• Patient Concierge
• Medical Review Specialists
• Care Navigators
• Others

Let’s work together to build a great Healthcare Team.

Infinit-O is the trusted customer-centric and sustainable leader in Business Process Optimization to Small and Medium businesses in the Financial Services, Healthcare and Technology sectors by delivering continuous improvement through technology, data and people.