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Medical Billing and Coding in New York

The world of medical billing and coding is forever adapting to change. The switch to the ICD-10 coding system in late 2015 represented one of the biggest changes – and challenges – to the profession. There are frequently small changes to code sets. There are often regulatory changes as well. One of the many changes on the horizon in 2017? The New York Attorney General's Office has determined that a state insurance company needs to change its policy of pre-authorization for medication-assisted opioid treatment as it is not consistent with mental health parity laws (http://www.healthcarefinancenews.com/news/following-cigna-anthem-changes-preauthorization-policy-medication-assisted-therapy-treatment).

Complexity and change: Two reasons non-clinical professionals need to be well-trained at all levels! The responsibility for ensuring that professionals can apply procedures and regulations (as well as apply tens of thousands of codes) largely falls to employers -- but they have a lot of help from third party certification agencies.

Select a New York Medical Billing and Coding Topic:

Billing and Coding Educational Program Options in New York

There are many educational options. Medical coding certificate programs often take about a year to complete. However, some students opt for very short training programs. Others opt for accredited health information degree programs. The prospective student may want to consider how well the curriculum aligns with the standards of national certifying agencies: What certification examinations will the student be eligible to take upon graduation? What examinations can he or she reasonably expect to pass?

A person can be certified as a medical biller. Certification as a coder is much more common. There are many certifications. The best-known and most respected nationwide are the American Health Information Management Association (AHIMA) and the AAPC.

Some prospective New York billers and coders may be eligible for short training programs that are free based on factors such as income status. Programs may prepare students for a particular examination such as the Certified Billing and Coding Specialist (CBCS) which is made available through the National Healthcareer Association. While this does have value, it is not nearly as widely respected or accepted as AHIMA and AAPC credentials.

Completion of an NHA-focused program does not mean that the person will not be able to take a higher examination – merely that taking and passing the CBCS is an expected part of the training process.

Internship is another consideration when selecting between programs. The medical billing and coding profession does not require internship. However, it can facilitate the path to earning higher credentials (as well as providing real-world connections).

AHIMA Certification

Individuals seeking certification through AHIMA often begin at the Certified Coding Associate (CCA) level. CCA candidates must demonstrate basic competency in coding across settings. There are no minimum educational standards beyond high school, but AHIMA does recommend that those new to the field have medical terminology, anatomy and physiology, and basic CPT and ICD-10 coding. The CCA examination is two hours.

Candidates may instead test for the Certified Coding Specialist (CCS) credential. This has long been the premier coding credential in hospital settings. Candidates who seek CCS certification must meet educational standards unless they have sufficient prior experience or hold other qualifying credentials. Students may opt for AHIMA-accredited programs. They may instead demonstrate coursework in medical terminology, anatomy and physiology, pharmacology, pathophysiology, reimbursement methodologies, and intermediate/ advanced CPT and ICD10 coding. The CCS examination is four hours. It includes medical scenarios.

Candidates register and submit eligibility documents and fees to AHIMA. Once approved, they schedule through Pearson VUE. The AHIMA website includes a link to search by location throughout the United States (http://www.ahima.org/certification).

AAPC Certification

The AAPC does not have a separate entry-level examination. However, individuals who pass the Certified Professional Coder (CPC) examination must begin at the apprentice level if they do not have experience. This is also the case with two other AAPC credentials: Certified Professional Coder-Payer (CPC-P) and Certified Outpatient Coder (COC).

Successful CPC, CPC-P, and COC examinees will have a one-year experience period. This is assuming they have completed educational programs of at least 80 hours. Otherwise the requirement is two years.

The AAPC does not impose an apprentice requirement for Certified Professional Biller (CPB). Nor does it impose one for Certified Risk Adjustment Coder (CRC) or specialty coding certifications. However, the CRC is recommended only for professionals who have completed courses in risk adjustment coding or have two years of experience in the discipline. Specialty medical coding certifications are recommended only for those with two years of experience in the particular specialty tested. AAPC career counselors can be reached at 877-290-0440.

AAPC candidates must register for scheduled examination. They may search on the AAPC site (https://www.aapc.com/certification/locate-examination.aspx). Some chapters host examinations on a regular basis. Albany, for example, has tests scheduled approximately once a month throughout 2017.

Earning Certification through Other Organizations

Occasionally, employers reference specialty coding certificates from other organizations, for example, the Home Care Coding Specialist-Diagnosis (HCS-D) credential issued by the Association of Home Care Coding and Compliance (https://ahcc.decisionhealth.com). Professionals may have a specified time after hire to earn specialty credentials.

Additional Resources

New York boasts 22 local AAPC chapters (https://www.aapc.com/localchapters/list-all-local-chapter.aspx). The following are among the educational events that local chapters have elected to cover:

  • Fraud: what you need to know
  • Hot topics for 2017 compliance
  • CPT code changes 2017

The state AHIMA chapter is the New York Health Information Management Association. Medical coders may also wish to be involved at the local level, through organizations such as the Health Information Management Association of New York City (www.nyhima.org).