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Medical Billing and Coding in Minnesota

Why has medical billing and coding gotten so complex? To learn some of the reasons, one can turn to Dr. Lynne Lillie of Rochester, Minnesota (http://blogs.aafp.org/cfr/leadervoices/entry/what_s_in_a_name). Lillie notes that a doctor can’t simply bill for a check-up. Payers need information about the purpose of the visit, the services provided, and the context. Sometimes visits have more than one purpose. Many factors determine how financial responsibilities are split between patients and their insurance companies.

Today’s ultra-precise coding is also important for medical research and innovation. In order to know what works, one needs to know the finer details of medical conditions, co-morbidity, and treatment.

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Medical Billing and Coding Education and Experience Details

What does all this mean to a billing or coding specialist? In today’s world, one needs to develop one’s skills – and demonstrate them. A person who does not have previous experience will likely need formal education before attempting a certification exam. Different employers set different educational standards. The Mayo Clinic requires medical coders to have education at at least the associate’s level (http://www.mayoclinic.org/jobs/career-profiles/medical-coder/details).

The rewards for expertise can be ample. The AAPC, one of two third party certification agencies widely accepted on a national level, released salary information in March 2016; this was based on survey responses provided by its own membership. The average salary for a certified professional in the West North Central Region was $48,314 in 2015.

The AAPC can provide information about the many factors that influence salary (https://www.aapc.com/blog/33226-2015-salary-survey-credentials-tip-the-scale/). It can also provide information about what it takes to succeed in the profession. So can the American Health Information Management Association (AHIMA), the other main certifying body.

Entry-Level Billing and Coding Certifications

The AHIMA Certified Coding Associate (CCA) certifying exam is unique in that it is designed to test coding proficiency at a lower level. Unlike other coding credentials offered by AHIMA, it is generalist; it is not focused on a particular type of setting. The CCA is a more realistic option for many at the entry-level but is not referenced in as nearly many job ads as higher level AHIMA credentials. An individual who is very well prepared can bypass the CCA.

The AAPC offers apprentice level examinations, but they are not based on taking an easier examination. A person who tests as a Certified Professional Coder (CPC), Certified Professional Coder-Payer (CPC-P), or Certified Outpatient Coder (COC) will be credentialed first at the apprentice level if he or she does not have experience.

Professional and Expert-Level Certifications

Both certifying agencies offer expert-level credentials. The CPC is among the most respected credentials nationwide. A professional can be hired into very advanced roles on the strength of the CPC, provided that he or she also has related experience. The CPC includes questions that are relevant to different types of settings but is most relevant for physician's offices. The Certified Inpatient Coder (CIC) is considered an expert credential.

Some professionals do choose to pursue specialty credentials. These are available in a wide variety of medical specialties, including Ambulatory Surgical Center, Anesthesia and Pain Management, Hematology and Oncology, and even Otolaryngology.

The AAPC also offers a Certified Risk Adjustment Coder credential. Risk adjustment models are an alternative to traditional pay-for-service. Professionals can also seek Certified Professional Biller (CPB) certification in order to validate their expertise with concepts such as claims lifecycle and follow-up, Local Coverage Determinations (LCD) and National Coverage Determinations (NCD), and types of insurance plan. The CPB includes some coding.

AHIMA also offers Certified Coding Specialist (CCS) and Certified Coding Specialist-Physician based (CCS-P) credentials. An individual can take either of these examinations on the strength of an AHIMA-approved program or a program that includes coursework in the following: medical terminology, anatomy and physiology, insurance reimbursement, pathophysiology, pharmacology, and intermediate/ advanced medical coding. However, the examination can be difficult to pass. AHIMA notes that the CCS-P is recommended only for professionals with substantial experience. The first-time CCS-P pass rate was only 45% in 2015.

The Minnesota AHIMA chapter issued congratulations to its members who had earned new certifications during the prior year (http://www.mnhima.org/education/education1.html). More than 30 candidates received their CCA. A dozen each were recognized as being newly credentialed at the CCS or CCS-P level. There were also a number of professionals who received Registered Health Information Technician RHIT or Registered Health Information Administrator (RHIA) certification. These credentials can qualify professionals for various health information management positions, including those that involve coding; candidates must have academic degrees in order to qualify and must, in most cases, complete CAAHIP-accredited education programs.

Schools often gear their curriculum toward particular certifications. There are other resources for making career decisions, even at the student level. Students may opt to join the AAPC or AHIMA. Among the AHIMA perks is mentorship.

An AAPC career counselor can be reached at 877-290-0440.

The Certification Application Process

Application materials can be downloaded from the AHIMA (http://www.ahima.org/certification) and AAPC (https://www.aapc.com/) websites. AAPC membership is a prerequisite for AAPC certification. AHIMA applicants must demonstrate that they have met prerequisite requirements at the time of application. CCS applicants who have experience may provide verification en lieu of documentation of having met coursework requirements. An individual certified at the CCA level need demonstrate only a year of experience in order to test for CCS.

Fees are variable. Applicants can generally expect to pay several hundred. The CCA is the least expensive of the commonly recognized examinations, costing $199 for members, $299 for nonmembers. Combined CPC membership and certification examination will, in some cases, run over $500. However, a free retake is included. Students have reduced rates.

Certification is maintained through continuing education.

Additional Resources

The Minnesota Health Information Management Association is the state AHIMA chapter (http://mnhima.org). There are seven regional associations; regional associations sometimes host coding roundtables and other events.

There are eleven local Minnesota AAPC chapters (https://www.aapc.com/localchapters/list-all-local-chapter.aspx).