Medical Billing and Coding Certification and Requirements

Medical billing and coding professionals are tasked with ensuring that payment requests made to insurance companies are accurate and complete. Because they have the financial well-being of health care facilities in their hands, it's imperative for these workers to receive extensive, quality training. To help ensure that they are hiring knowledgeable workers, many organizations require that billing and coding employees receive a professional certification. There are a number of certifications available for these workers, some of which are offered by the American Health Information Management Association (AHIMA) and the American Academy of Procedural Coders (AAPC). The requirements for certifications generally include working in the field for a certain amount of time, completing continuing education courses, or passing an examination.

Although medical coding and billing can be done by the same person, they are actually two distinct functions, and professionals can obtain a certification for each one. Coding certifications -- such as the Certified Professional Coder (CPC) and Certified Professional Coder-Hospital Outpatient (CPC-H) offered by the AAPC -- test on knowledge of medical codes for diagnoses and procedures, reimbursement guidelines, medical terminology and what to do when a claim is denied.

Similarly, billing certifications like the Certified Professional Biller (CPB), allows professionals to demonstrate their knowledge about types of insurance plans, the life cycle of a medical bill, and how to follow up on a medical claim.

Educational requirements for medical billing and coding

To embark on a career in medical billing and coding, candidates are required to complete a high school diploma, or its equivalent, and are encouraged to take courses in health, math, biology, and computer science. After graduation, they may be required to obtain an associate degree or a postsecondary certificate that may take about one year to complete. According to the Bureau of Labor Statistics (BLS.gov), some employers also require that employees earn a professional certification in addition to a billing and coding degree.

Benefits of billing and coding certification

Certification may be a condition to gain employment in some cases, but it may also help some workers advance in their careers and gain the potential to boost their salaries. According to a survey conducted by AAPC, medical coders and billers who earn a professional certification generally make 20 percent more than those who do not.


Medical Billing and Coding Certification, Ultimate Medical Academy, Accessed June 23, 2014, http://www.ultimatemedical.edu/education/medical-billing-and-coding-certification

Medical Certification Overview, AAPC, Accessed June 23, 2014, http://www.aapc.com/certification/

Medical Records and Health Information Technicians, Bureau of Labor Statistics, Occupational Employment Statistics, January 8, 2014, http://www.bls.gov/ooh/healthcare/medical-records-and-health-information-technicians.htm

Six Steps to Becoming a Certified Medical Coder, Find A Code, Accessed June 23, 2014, https://www.findacode.com/articles/six-steps-to-becoming-a-certified-medical-coder.html

What is Medical Coding?, AAPC, Accessed June 23, 2014, http://www.aapc.com/medical-coding/medical-coding.aspx

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