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Medical Billing and Coding in Oregon

Patient diagnoses and medical encounters: These are all recorded by medical billers and coders -- and sometimes the information goes further than one might imagine. Oregon Health and Science University, for example, recently analyzed claims from the state’s Accountable Care Organizations (ACOs) and used the data to determine that the model was working (http://www.beckersasc.com/asc-coding-billing-and-collections/acos-yield-gains-over-time-effective-in-reducing-costs-6-findings.html). In short, billing and coding information not only determines how much payers get charged but also informs health and policy research.

It takes skilled professionals to navigate health systems that utilize tens of thousands of codes, that figure payments in a variety of innovative ways… and that are constantly adapting to change. Billing and coding specialists are not state-licensed, but it is increasingly common for employers to require third party certification. Fortunately, certification is highly portable. Credentials granted by AHIMA and the AAPC are recognized not only in Oregon but around the nation.

Select an Oregon Medical Billing and Coding Topic:

Medical Billing and Coding Education in Oregon

Medical billing and coding specialists typically need some post-secondary education. They may or may not hold academic degrees. Associate’s degrees are often recommended. The degree may or may not be in a closely related field. Medical coding education often results in the awarding of a certificate.

Students may select from comprehensive programs or narrowly focused ones. Some programs emphasize medical billing; they may include only basic coding. Some emphasize physician's office or 'practice' coding; this has traditionally been considered the easier market to break into.

Programs may be designed to help students meet requirements of particular certification examinations. Some schools utilize the curriculum or technology of the certifying agency.

Certifying agencies are also professional organizations. Schools may maintain strong ties to one or the other. Student-level membership may be encouraged. Membership fees are lower at the student level. Students and new graduates will find various resources to help them begin their careers.

Medical Billing and Coding Certifications

The AHIMA Certified Coding Assistant (CCA) is a respected but basic credential, applicable to coding across settings. Lower level positions may note the CCA. Candidates are not required to demonstrate formal post-secondary training, but some coding-related coursework is recommended. The CCA is the least expensive of the widely recognized credentials, costing $199 for members ($299 for non-members).

The AHIMA Certified Coding Specialist (CCS) and Certified Coding Specialist-Physician based (CCS-P) are recommended for more experienced candidates. These certifications include scenarios relevant to the specific medical setting.

Individuals who certify through the AAPC will take a professional-level examination at the onset; there is no separate associate-level examination. However, a candidate who passes the Certified Professional Coder (CPC) examination yet lacks the experience deemed necessary for full professional certification will receive a Certified Professional Coder-Apprentice (CPC-A) designation. Those who take the Certified Outpatient Coder examination have a similar process. The Certified Professional Biller (CPB) credential, however, does not have an apprenticeship requirement. Neither does the Certified Inpatient Coder (CIC). It is considered expert-level, however, and is not intended for medical coders who do not have considerable experience.

The CPC offers many expert-level certifications, some of which correspond with medical specialties. Generally, candidates should attempt these only after they have expertise in the specialty area. The Certified Risk Adjustment Coder (CRC) is recommended for professional who have either performed the duties on the job or completed a risk adjustment course.

AHIMA examinations are administered through cooperation with Pearson VUE. Applicants who have had their candidacy approved by AHIMA (http://www.ahima.org/certification) will be issued ATTs that they can use to self-schedule. One can find Pearson Vue Professional Centers in Salem, Beaverton, and Medford, as well as in many other municipalities around the nation.

AAPC examinations are administered on the dates and times listed on the AAPC website (https://www.aapc.com/certification/locate-examination.aspx).

Certificate holders have continuing education requirements. AAPC certificate holders have only a slight increase for additional credentials that they earn but must meet specific requirements associated with particular credentials.

Additional Employer Expectations

Employers sometimes administer their own coding assessments. They may monitor their hire’s accuracy scores. A hire may be evaluated based on maintaining high levels of coding (for example, 95%).

Billing and coding professionals may utilize programs like 3M and/or TruCode encoder for reimbursement and assignment of DRGs; employers sometimes reference these in job ads.

Some ask for experience with systems used with particular governmental payers – i.e. CMS Hierarchical Condition Categories (HCC) Risk Adjustment coding.

Employers may define coding specialists by level (I, II, III, IV). A recent posting for Coder I (a high level position) noted among the duties audits and evaluations; the hire would offer provider support with evaluation and management and HCC coding.

Some experienced medical coders are hired into remote medical coding positions. Hiring may be very broad, or there may be a geographical element. One recent posting sought medical coders from Alaska, California, Montana, Oregon and Washington.

Career Recognition

The AAPC offers a distinguished member program. This is separate from certification. In order to be recognized, a member must have an employer recommendation. He or she must earn community engagement points. Continuing education requirements are also slightly higher for distinguished members. There are three levels of distinction: Associate, Professional, and Fellow (https://www.aapc.com/recognition/). Status as a Fellow can only be achieved by professionals with at least 10 years in the field. Associate status may be achieved after three years. Again, this is very different from associate certification. The professional may already hold various professional certifications.

Additional Resources

The Oregon Health Information Management Association is the state AHIMA chapter (http://www.orhima.org).

Oregon boasts ten local AAPC chapter (https://www.aapc.com/localchapters/list-all-local-chapter.aspx).

Among the topics that have been scheduled for presentation at local chapters in 2017 are the following:

  • Highlights of Evaluation and Management Services
  • Resume Workshop and Interview Tips
  • Coding in High Risk Populations