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Medical Billing and Coding in Wisconsin

"Is coding hard?" Madison Area Technical College has been asked this question so many times that they have prepared a document on the subject (https://madisoncollege.edu/program/medical-coding). Coding is indeed hard, and it takes sound critical thinking skills, according to Madison students. Doctors don’t necessarily spell out what a patient’s primary and secondary diagnoses are – and sometimes they use language that’s counterintuitive. In order to make sense of medical records, coding specialists need some knowledge of medical terminology, anatomy, and disease processes. As for coding guidelines: there are many.

In short, diagnosis coding can be tricky. And billing and coding specialists must also code for the care received. These days there are various complex systems for doing so. These are some of the reasons why healthcare employers look for billing and coding specialists who are well-prepared.

It’s fortuitous that there are plenty of resources in Wisconsin and online. Coding eventually does become easier. And the salary can make other aspects of life easier as well.

Select a Wisconsin Medical Billing and Coding Topic:

Medical Billing and Coding Education

Medical coding education can be obtained through Wisconsin colleges. The program will like result in a technical certificate.

There are a number of other options. Some students opt for short programs designed to meet requirement of their certifying agency. Some opt for degrees in health information management. There is no industry-wide standard for post-secondary education, though some organizations recommend two-year degrees – and some employers expect them. There is some cross-over value for education in other disciplines. Individuals who already have education at the associate’s level may opt for coding programs that prepare them for certification and career success. Some Wisconsin employers, notably, do specify completion of a coding program (or of core coursework such as medical terminology).

Medical Billing and Coding Certification Overview

Medical coding certification is not a mandate but is becoming an expectation. Most employers cite certifications issued by the American Health Information Management Association (AHIMA) and the AAPC. Occasionally, one will find references to other certifications, for example, the Board of Medical Specialty Coding and Compliance (BMSC) Specialty Coding Professional (SCP).

Many Wisconsin employers list a variety of AHIMA and AAPC certifications as acceptable, though some have preferences. Health information management certifications are sometimes accepted en lieu of coding certification. Occasionally one will find a position where the preference is for both health information management certification and coding certification.

One achieves certification by passing an examination and, in some cases, meeting additional prerequisite requirements set by the certifying agency. A portion of the examination generally consists of "open book" coding; the certifying agency specifies which code books are acceptable. Some tests include more difficult coding than others. The bulk of the examination is typically multiple choice. However, some difficult examinations include open-ended coding questions. The test taker will need to understand a variety of concepts, including regulations and policy. Coding needs vary by setting, and this is reflected in examination content.

Common Medical Billing and Coding Certifications

AHIMA: The AHIMA Certified Coding Associate (CCA) is appropriate for professionals just beginning their careers. It tests competency across settings.

The Certified Coding Specialist and Certified Coding Specialist-physician based are designed to measure expertise. It is often advisable to put off taking these examinations until one has some experience in the field. However, individuals who complete programs that include all content mandated by AHIMA can take the CCS or CCS-P at the onset. Those who complete accredited health information degree programs and achieve Registered Health Information Technician (RHIT) or Registered Health Information Administrator (RHIA) certification can also test at the CCS or CCS-P level without providing evidence of additional qualifications.

AAPC: The Certified Professional Coder (CPC) is the best-known AAPC credential. It is particularly well-suited for professionals in doctor's office or "practice" settings. There is no separate associate or apprentice level examination available through the AAPC. However, successful candidates who lack experience are credentialed first at the Certified Professional Coder-Apprentice (CPC-A) level.

A candidate can opt first for the Certified Outpatient Coder or Certified Professional Coder-Payer certification if the alternative certification is more appropriate to his or her work setting. Both these certifications have an experience/ apprenticeship requirement. Some professionals may opt for the Certified Professional Biller credential instead. (Certified Inpatient Coder is also among the AAPC offerings but is not recommended for entry-level professionals.)

A professional coder may handle coding for one or more medical specialties. The AAPC offers specialty credentials in a variety of areas. Certified Evaluation and Management Coder (CEMC) is among the certifications recently referenced by a Wisconsin employer. Also available through the AAPC are risk adjustment coding and auditing certifications.

Prospective AAPC credential holders must hold membership in the organization. Examinations are hosted by local chapters. Prospective examinees can search for locations and test dates on the AAPC site (https://www.aapc.com/certification/locate-examination.aspx).

AHIMA does not require organizational membership but does offer members a discounted examination fee. There are many additional membership perks. AHIMA candidates must provide documentation that they have met all prerequisite requirements before they can be approved for examination (http://www.ahima.org/certification). Fees are also due at the time of application. An approved candidate will receive an Authorization to Test. He or she can schedule through Pearson VUE.

Medical Billing and Coding Salaries in Wisconsin

Local schools may provide information about typical starting salaries. Professional associations can provide information about average salaries of their certificate holders. The AAPC surveyed its membership and reported an average salary of $48,584 for the east North Central Region (https://www.aapc.com/blog/33226-2015-salary-survey-credentials-tip-the-scale).

Additional Resources

There are six local Wisconsin AAPC chapters, located in Appleton, Green Bay, La Crosse, Madison, Milwaukee, and Wausau.

The Wisconsin Health Information Management Association is the state AHIMA chapter (http://www.whima.org/). WHIMA has a mentorship program (http://www.whima.org/resources/mentor-program/).