What are the medical coding certification requirements?


The Medical billing and coding profession is becoming popular day by day with the rapid growth in the healthcare industry. Medical coding and billing experts are highly in demand because now, precisely coded documents are necessary for the physician to receive their payment. Moreover, every organization has its unique coding and form filling requirements, which in-turn requires a trained coding professional.

However, it is highly recommended to acquire a certification before starting your journey as a medical coder. It is not legally required but is highly recommended because most of the employers prefer the certified coders, over non-certified coders. Additionally, it will show your passion and dedication towards the profession to the employer. Certification indirectly makes a positive impact on your resume and increases your chances of getting hired. The same results were shown when a research was conducted by AAPC; the final results were that the average income of a certified coder is 20 to 30% higher than the non-certified coders.

There are numerous credentials that a medical coding and billing specialist can get a certification for, but the CPC, ‘Certified Professional coder’ and the CCS, ‘Certified coding specialist’ remain the most popular choices among the aspiring coders. Those who take the academic path also find better employment opportunities, once they are certified. Again, it is not necessary, but increases your chances of impressing the potential employer. A medical coding and billing instructor should be certified either by AAPC (American Academy of Professional coders) or AHIMA (American Health Information Management Association). There are several other certifications available offered by various organizations. However, they may not be recognized by the potential employers. For this reason, it is best to obtain your certification either through AAPC or AHIMA. Other recognizable organizations include ‘American Medical Billing Association (AMBA)’, ‘Board of Medical Specialty Coding and Compliance’ and the ‘Professional Association of Healthcare Coding Specialists (PAHCS)’.

Kristy Feldmen
Senior Editor

The following summarizes the coding and billing requirements for each of these organizations:

AAPC

The ‘American Academy of Profession coders’ provide three types of certifications for the medical coding and billing professionals that includes “CPC- Certified professional coder”, “CPC-P : Certified professional coder- payer” and “CPC-H : Certified professional coder- hospital outpatient”. The medical coders and billers can also apply for the extra credentials in specialties like emergency, cardiology, pediatrics, dermatology and internal medical coding and billing. A person who wants to apply for the CPC examination must be a member of AAPC society and must have a minimum of 2 years’ experience as a medical coding and billing expert. Once certified, in order to maintain the certification, the person must complete a 36 hour educational unit, every 2 years. It is recommended to have an associate’s degree but is not required for the CPC examination.


The AAPC has also launched a nationally recognizable billing certification recently; the CPB- ‘Certified professional biller’. The credentials taught within this certification mainly focus on the medical billing, but also include a few basics of medical coding. This course contains study material of about 80 hours and can be completed within a 4 month time span or less depending upon the student. Those who want to take up this certification course are required to take courses in the subjects of medical terminology, anatomy and physiology. A student can log-in whenever it is convenient, starting from the date of enrolment. A student must complete at least 1 module, every week. This billing certification also qualifies for the college credits of students who attend the University of Phoenix.

AHIMA

The ‘American Health Information Management Association’ offers two certifications; CCA- the’ Certified coding associate’ and CCS-P : the ‘Certified coding specialist- physician based’, both of which are accredited by the ‘National Commission for certifying agencies’. The CCA credential is offered to those coding specialists who have a high school diploma and have a prior working experience in both doctor’s offices and hospitals, while the CCS-P credentials are offered to those coding specialists who have extensive experience in the outpatient clinics. The CCS-P certification also requires the applicant to either have a combination of prior certification and work experience of one year, or a prior credential, work experience of 2 years and an in-depth coding education. Moreover, in order to maintain the certification, the candidates must complete a 20 hours additional educational unit, every 2 years.

AMBA

The ‘American Medical Billing Association’ offers a nationally recognized medical billing certification course- the CMRS; Certified medical reimbursement specialist. Only the members of AMBA are eligible to write the CMRS certification exam. Graduates are also required to renew the CMRS credentials annually by taking 15 continuing educational units. About half of the annual CEUs are a combination of either local AMBA training, chapters, courses or from the pre-approved ‘CEU list’ and annual conference. There is no particular course requirement to write the CMRS examination. However, it is recommended to have prior coding or billing training before taking the exam.

BMSCC

The ‘Board of Medical Specialty coding and compliance’ provides a certification for SCP- the ‘Specialty coding professionals’ credentials, which requires a minimum 2 year experience in the specialty coding, and for ACS- the ‘Advanced Coding specialists’, which requires a minimum of 3 to 5 years’ experience of specialty coding. Also, in order to maintain the credentials and certifications, the candidates must complete 20 hours of additional educational units, every year.

PAHCS

The ‘Professional Association of health care coding specialists’ provides certification in CSMCS- the ‘certified basic medical coding specialist’ certificate and some other specialty certifications in areas like gynecology, podiatry, family practice and pain management. The applicants are not required to have completed any academic course or programs before completing this examination. However, in order to maintain the certification and credentials, the candidate must take up 24 hours of additional educational units.

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