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Medical Billing and Coding Certification

Medical billing and coding is not a licensed profession, but credentials do matter. The AAPC reports that certified coders earn an average of 20% more than coders without certification.

New graduates from medical billing and coding schools can often find entry-level employment in smaller physician offices and some health care facilities, but the larger health care practices and organizations will want to see 6 months to one year of work experience and national certification. This is not a bad thing. Many medical billers and coders take jobs upon graduation and study for the certification exam while employed. In many cases, graduates have had their certification exam costs reimbursed by employers and the work experience gained in that time is invaluable.

You earn certification by passing an examination. There are multiple certifying agencies for medical coders, but they’re not all equal. The two that are best known and most respected around the nation are AHIMA and the AAPC. Each offers several credentials.

The American Academy of Professional Coders (AAPC - www.aapc.com) offers three certifications including, CPC, CPC-H and CPC-P. The AAPC offers the CPC (Certified Professional Coder) certification, which is most useful for coders in physician’s office settings. There is also the CPC-H, which is for hospitals and the CPC-P, which is geared toward payers (health plans or Medicare).

When you first earn your AAPC certification, there will be an ‘A’, which stands for apprentice --e.g. CPC-A or CPC-H-A. This can be a disadvantage when you apply for jobs (especially in tight markets). You can remove the ‘A’ from your certification by verifying two years of on the job experience or eighty hours of coursework plus one year of experience. Externships do count toward the experience requirement. These nationally recognized certifications are considered the gold standard in medical coding certification. You'll find medical billers and coders with this certification working in physician offices, hospitals and other top tier health care organizations.

AHIMA certifications don’t have the apprentice designation, but there are still different levels of certification. The key to getting a higher certification is not years on the job -- at least not in a direct way. It can be very hard to earn the higher credential, though, unless you have a lot of experience or are a whiz at studying. The CCA (Certified Coding Associate) is the easiest to earn, but is not as highly valued. The CCS (Certified Coding Specialist) is more of a gold standard, but the exam is far more difficult. Fewer than 50% of candidates pass on a first attempt. AHIMA also offers certification in health information management.

The American Medical Billing Association (AMBA) offers the Certified Medical Reimbursement Specialist credentials. (www.ambanet.net/AMBA.htm)

In addition to basic credentials, there are a number of specialty credentials offered through the AAPC. These demonstrate advanced knowledge of coding in particular medical specialties.

For a medical coder, education is ongoing. Continuing education is required for recertification through either organization.

Make sure you speak with your employer or your prospective employer to learn about which coding and billing certifications they require prior to studying or taking an exam. If you haven't yet earned a degree in medical billing and coding, health care administration or health care information management, you may wish to read more about available medical billing and coding degree programs and the medical billing and coding career profile.

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