Medical billers and coders serve an important function in health care. Hospitals, doctor offices and other health care facilities rely on these professionals to navigate the complex world of health insurance rules and regulations. There are more than 30 different medical billing and coding certification options, ranging from general credentials to specialty designations for various type of medical care. Specializing in one or more of these credentials can increase both salary and job prospects. Ready to take your career to the next level?
What Medical Billing and Coding Certification Means?
If you’ve already
graduated from a medical billing and coding program, you may wonder
why you need to be certified, too.
can vary in quality, and certification provides employers with a
standard by which to judge a person’s expertise. Plus, they can
help distinguish between billers and coders with general knowledge
and those with specialized skills. Certification can prepare you for
more advanced medical billing and coding jobs and may lead to
increased salary, as well. Let’s see how it all works, and which
online certifications may be available to you.
The Certification Process
process begins with getting the right education. Start by earning
your high school diploma or GED and then applying for an accredited
billing and coding program.
– such as the AAPC’s Certified Professional Coder designation –
recommend an associate degree, but that’s not required. A few
credentials, such as the Certified Coding Associate from the AHIMA,
suggest postsecondary education but don’t have any minimum
education requirements beyond a high school diploma. Some
certifications may allow applicants to substitute work experience for
education while advanced designations may require both a
postsecondary education and work experience.
Once you have the
right level of education or experience, the next step to
certification is to take an examination. To be eligible for the exam,
you’ll need to pay a fee, and you may be required to join the
credentialing organization. In other words, AAPC and AHIMA will only
certify people who are members of their respective association.
After passing the
exam, you may have to renew your certification on a regular basis. To
do so, you may be required to complete a certain number of continuing
Medical Coding Certification Online
Now that we’ve established why certification is important, let’s explore the various options available. There are two main certifying organizations, and both offer several coding designations. Let’s take a closer look at each one.
Founded in 1988, the
AAPC was originally known as the American Academy of Professional
Coders. It has grown to encompass more than 180,000 members worldwide
and offers 28 different certifications for professionals working on
the business side of health care. The group offers four designations
specifically for coders.
Professional Coder (CPC) – AAPC describes this as the gold
standard for coders working in doctor office settings. A CPC is
expected to have mastery of all code sets – CPT, ICD-10-CM and
HCPCS Level II – as well understand how to handle claims denials,
charge captures and other issues.
Outpatient Coder (COC) – This credential is for those with the
expertise needed to work in outpatient facilities such as emergency
departments, therapy offices and diagnostic centers. AAPC anticipates
career opportunities in outpatient facilities may rise as physicians
move away from private practice and increasingly join hospital
Inpatient Coder (CIC) – This new certification is the only
credential specific to inpatient medical coding. It’s intended for
coders who work in hospitals or other inpatient facilities.
Adjustment Coder (CRC) – As another new certification option,
the CRC indicates a coder’s ability to read a medical chart and
assign correct diagnosis codes. In addition to understanding medical
coding guidelines, CRC applicants must know the audit process and
documentation requirements for risk adjustment coding.
The American Health
Information Management Association has been serving health
information management professionals since 1928. The group has more
than 103,000 members which it serves through a variety of
professional development opportunities. For medical coders, it offers
the following certification programs.
Associate (CCA) – The CCA is a general certification offered by
AHIMA and appropriate to coders working in both hospital and
physician office settings. Those with the credential are said to
exhibit the competency, commitment and professional capability sought
Specialist (CCS) – This certification is designed for those who
will be classifying medical data, such as those working in a hospital
setting. AHIMA notes the skills of a CCS may also be needed by
researchers and public health officials as they monitor health
patterns and interventions.
Specialist-Physician Based (CCS-P) – The CCS-P designation is
for those who specialize in physician-based settings such as doctor
offices, group practices or specialty clinics. Applicants for this
credential must have an in-depth knowledge of the CPT coding system
as well as an understanding of the ICD-10-CM and HCPCS Level II
In addition to the
core medical coding certifications, coders also have a handful of
specializations from which to choose. These are from the AAPC and
also require certification exam and, in many cases, a certain level
of experience. Here are the 22 medical coding specializations that
professionals in the field have as options:
Surgical Center (CASCC)
and Pain Management (CANPC)
and Thoracic Surgery (CCVTC)
and Management (CEMC)
and Oncology (CHONC)
Radiology and Cardiovascular (CIRCC)
- Plastics and
Reconstructive Surgery (CPRC)
- Surgical Foot
and Ankle (CSFAC)
- Urology (CUC)
Visit the AAPC’s page on specialty medical coding certifications for details on each, including how to prep for the exams and, when you’re ready, how to schedule one.
Medical Billing Certification Online
There are also certifications for medical billing although the options here aren’t as extensive as what is offered for coding. There are two main options for billers to demonstrate their ability to manage claims to private insurers and government health plans.
Professional Biller (CPB)
Offered by AAPC, the
CPB credential is awarded to billers who have demonstrated expertise
in all aspects of the revenue cycle. To earn this certification, you
must have knowledge of various type of insurance plans, coding
guidelines and laws pertaining to health care billing such as HIPAA,
False Claims Act and Fair Debt Collections Act.
those applying to be a CPB have an associate degree. Applicants must
be members of AAPC and score at least 70 percent on a 200-question
multiple-choice certification exam. The exam costs $425, or $325 for
AAPC students, and is an open code book test, allowing the use of
certain approved manuals.
Certified Medical Reimbursement Specialist (CMRS)
certification for medical billers comes from the American Medical
Billing Association. Founded in 1998, the organization provides a
number of professional development opportunities for medical billers.
Among these is the CMRS designation.
Unlike other coding
and billing certifications, there are no education requirements for
those wishing to take the CMRS exam. Any member of the association
who has current year code books is eligible to apply although the
AMBA recommends applicants use a study guide to prepare for the exam.
certification exam is extensive and includes 710 questions spread
across 16 sections. A score of 85 percent is needed to pass. The exam
costs $325, and applicants have a 45 day enrollment period in which
to complete it.
Preparing for the Exam
A quality medical coding and billing program should cover all the major content areas tested by certification exams. However, it’s still wise to do some additional preparation to maximize your chances of earning a passing score. Here are a couple options to help you prepare.
guides: The AAPC offers study guides for each of its
certifications. These guides won’t teach you coding but do offer a
review of the coding concepts you learned in your medical billing and
Each task force that
creates an AAPC certification exam also develops the corresponding
study guide. Within the guide, there are testing tips and techniques
to help applicants maximize their opportunity for success. Each study
guide also includes a review of medical terminology and anatomy,
practical examples and sample questions that are designed to mimic
those on the exam.
The AAPC study
guides cost $99.95 for members of the association. Non-members pay
AAPC practice exams: The AAPC also offers practice exams for its certifications. These 50-question exams are designed to replicate the content and difficulty of the official certification exams. They prove immediate feedback, and once purchased, you can take each practice exam as many times as you’d like. Your results can provide a gauge of your readiness for the actual exam.
Each AAPC practice
exam costs $39.95 for members and $69.95 for non-members. There are
several practice exams available for each certification, and they may
be purchased individually or in bundles of three. The bundle price is
$79.95 for AAPC members and $109.95 for non-members.
No Cost Prep:
In addition to official study guides and practice exams, you can find
free test prep resources online. These include apps and websites with
sample questions, webinars and practice quizzes. The quality of free
resources can vary, and be sure you are using study materials for the
latest version of each coding system.
Here are a couple
places to start looking for no cost prep.
The Career & Salary Impact of Certification
Earning a medical billing and coding certification can have a significant impact on both your job opportunities and income. Many employers seek our certified coders and billers and are willing to pay more to hire them. According to a 2017 salary survey by the AAPC, professionals with at least one certification earn nearly 15 percent more than those without any certification.
- Medical Biller Salary
Salaries can vary depending on several factors, but the average AAPC medical biller earns more than $61,000 annually. That was the conclusion of the 2017 AAPC salary survey. However, actual incomes can vary depending on a person’s geographic location, certifications and years of experience. Across the board, biller salaries increased 4.8 percent from 2016 to 2017.
The AAPC salary survey notes that billers with a CPB certification have an average of 12 years of experience. They also average three certifications, including the CPB. Those with experience may go on to work as billing managers, a position that comes with an average salary of $64,623, making managers among the highest-paid professionals in the field.
- Medical Coder Salary
The average AAPC coder doesn’t make as much as the average biller, but they still earn $52,411 per year according to the 2017 AAPC salary survey. Earning a medical coding certification can significantly increase a person’s salary potential too.
Coders who are not
certified earn an average annual salary of $45,032. Obtaining one
certification bumps average incomes up $6,442 to $51,477 per year.
Those with two certifications earn $57,656, and coders with three or
more credentials have an average salary of $66,659.
The type of
certification can also impact a coder’s salary. Here are the
average salaries for those with AAPC coder credentials in 2017:
certification, incomes can vary by region and state. The highest
paying region in the country is in the states along the Pacific Ocean
where coder incomes average $60,011. The lowest paying region is the
East South Central states of Alabama, Kentucky, Mississippi and
Tennessee. Although incomes are lower here than elsewhere in the
country, coders still earn an average of $49,209 annually in this
Education is another
component of coder salaries. Not surprisingly, those with higher
levels of education tend to make more than those with no
postsecondary training. Here’s a closer look at average coder
salaries, broken down by years of college:
college/associate degree: $50,987
degree or higher: $69,378
While these numbers
can provide a guide as to what to expect in terms of income, actual
salaries can fluctuate based on a coder’s certifications, years of
experience and work setting. For instance, inpatient hospital coders
typically earn more than those who work for a solo or small group
What’s Next for Medical Billers & Coders?
Medical billing and
coding can be a launching point for a variety of careers. Moving to a
billing and coding manager position is a common career path for
professionals in the field, but it’s not the only option.
Some billers and
coders shift to new responsibilities as office managers or auditors.
While office managers may oversee all administrative operations in a
practice, auditors are responsible for checking the work of coders
and billers to ensure it is accurate and meets regulatory
requirements. The AAPC offers a Certified Professional Medical
Auditor credential for those working in this capacity.
As an occupation
within the category of medical records and health information
technicians, billers and coders should have positive job prospects in
the coming years regardless of how they plan to advance their career.
Overall, health information technicians should see 13 percent job
growth from 2016-2026, according to the Bureau of Labor Statistics.
The federal agency notes employment opportunities may be best for
those who have obtained certification.