Certification – Medical Billing and Coding PRO

It is estimated that more than 87,000 professionals in health care industry in United States hold medical billing and coding certification approved by AAPC. They are employed in clinics, hospitals, physician offices, and outpatient facilities. These professionals are employed as medical auditors, billers, compliance officers, coding executives and practice management team members. These coders and billers process, submit and follow up on insurance claims to ensure receipt of payments for services offered by healthcare providers. A similar process is used by insurance companies. Medical billers not required by law to be certified in their line of work. The exams offered by various boards are RHIA Exam, and CMRS Exam. Certification schools provide a theoretical ground for students who enter the medical billing and coding field.

Good career

There is a surge of demand for the medical billing and coding professionals. If you want to work in health information field and have the following skills, then medical billing and coding career is right for you-

  • You enjoy working in allied medical field
  • You are detail-oriented
  • You can recall and remember without difficulty
  • You are technically skilled to use computer easily
  • You enjoy learning and you do not mind being trained to pursue and allied medical career
  • You like a routine job

Kind of work

The size of the medical facility you work for may affect your responsibilities and duties in medical coding and medical billing. The volume of data handled in large hospitals is much higher and more detailed compared to smaller clinics. You will realize that medical coders and billers are professionals who specialize in certain areas of health information. At smaller facilities, these professionals work in all areas. Though they specialists usually work in different health care facilities and hospitals, they have minimum interaction with patients. This career is good for those who do not enjoy customer and patient interactions but are good at vendor management. They focus on mostly operational, administrative work along with managing paperwork, database and information that is needed to keep records organized.

 

Medical Billing Certification

The healthcare business requires certified billers who can handle all aspects of revenue cycle. Without them, The Certified Professional Biller (CPB) has to take a rigorous exam and experience. The person has to know how to follow government regulations to submit claims, resolve claim denials, follow-up on statuses, post payments, submit appeals, handle adjustments and manage collections. Medical billing certification is vital to run the financial processes that ensure revenue generation and achieve success in professional claims process services.

Medical Coding certification

The medical billing and coding certifications are recognized in United States by physicians, employers, government organizations and societies. The Center for Medicare and Medicaid (CMS) recognizes this certification. The Bureau of Labor Statistics states that most employers prefer certified professionals as they have the basic knowledge of medical terms and billing codes. It is seen that certified coders earn more than 17% salary earned by non-credentialed coders. Hence AAPC approved certifications are necessary for those interested in engaging in allied medical career

Medical Auditing Certification

To advance your career the Certified Professional Medical Auditor (CPMA®) credential ensures a job in medical auditing. It is necessary to be compliant and run a profitable physician practice. Whether it is private payer denials, RAC audits, or just mental peace, more physicians have to go through regular audits. There is high risk if a medical practice is not compliant with coding and documentation norms. As Certified Professional Medical Auditor, you will use your knowledge and skills in billing, documentation and coding to improve revenue cycle of the business you work for. The skills include-

  • Knowledge of fraud, abuse, medical documentation, and penalties for coding and documentation violations of governmental guidelines
  • Coding Concepts
  • Statistical Sampling Methodologies and scope of coding
  • Abstraction Ability and skills in auditing Medical Records
  • Analysis of Coding Risk and Quality Assurance
  • Communication of findings and results
  • The Medical Record

 

Medical Compliance certification

Healthcare compliance certification deals with ever-growing requirements of adhering to government regulations, policies, laws and rules. Medical practices require someone who has the ability to organize, manage, develop and direct various functions of the compliance department. The Patient Protection and Affordable Care Act (PPACA) of 2010 approve the compliance programs that have become mandatory for enrollment in the Federal healthcare programs.

As individuals, holding the AAPC’s Certified Professional Compliance Officer enables you to demonstrate an understanding of basic requirements to implement, monitor and develop a healthcare compliance program for your facility. Based on governmental regulatory guidelines there is need for audits, internal compliance reviews, staff education and training and risk assessments. There is a rise in the number of medicare / medicaid fraud and abuse. Hence there is an impending requirement for mandatory compliance of physician practice programs,

CPCOs will have demonstrated knowledge of:

  • The Compliance Guidance for Individual and Small Group Physician Practices,
  • Effectiveness of Compliance program
  • False claims act for key healthcare abuse and frauds
  • Other laws and regulations including EMTALA, HIPAA, and CLIA
  • Self-disclosure protocols and handling investigations
  • Corporate Integrity Agreements (CIAs) and Certificate of Compliance Agreements (CCAs) requirement
  • Current investigative activities (ZPICs, MFCUs, RACs)
  • Handle conflicts of interest and gifts/gratuities,

The CPCO Certification Exam

  • 5 hours and 40 minutes to take the test
  • 150 multiple choice questions
  • $325.00
  • 1 free retake within one year of first attempt
  • Open reference (approved references)

The CPCO certification exam thoroughly covers-

  • Healthcare Compliance Program
  • Compliance program guidelines for physicians and group practices
  • Fraud and abuse laws
  • Other laws and regulations
  • Investigations and audits

Practical Manager Certification Exam

This exam needs to have detailed requirements and responsibilities for managing compliance regulations, health information, revenue cycle, human resources and general operative processes that challenge practice management The Certified Physician Practice Manager (CPPM) qualification is taken by those who have strong healthcare experience. They are prepared to enhance their occupations in management of physician practice this certification also helps existing practice managers as it increases knowledge and validates their experience.




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