According to a recent report from the Kaiser Foundation, Americans spent more than $2.5 trillion on healthcare in 2010; to properly manage all of the claims that generated this large amount, billing professionals in the industry must be trained not only in medical terminology, but also private and governmental policies, laws, and regulations. Many demonstrate this expertise by obtaining a medical billing certificate.

Reasons for Getting Certified

Certificates provide better pay, greater job security, and more opportunities for career advancement. Government data indicates individuals who receive supplemental education are likelier to be employed and earn a high salary. This is certainly true for medical billing certificate holders, who earn 20% more than their less-educated colleagues, according to a recent study published by Georgetown University’s Center on Education and the Workforce.

Choosing a Certification Provider

There are a number of medical billing certification providers. Some of the most prominent organizations include:

  • American Academy of Professional Coders (AAPC): Those who wish to specialize in billing frequently choose AAPC’s Certified Professional Biller (CPB) credential. This certification demonstrates knowledge of submitting claims, complying with regulations and insurance company policies, resolving denials, handling appeals, and managing collections. CPBs generally find work in doctor’s offices, outpatient facilities, clinics, and hospitals.
  • American Health Information Management (AHIMA): Candidates who desire a generalist credential may prefer AHIMA’s Registered Health Information Technician (RHIT). This program focuses on ensuring record accuracy and coding records for both reimbursement and research. Certificate holders with experience often move into management, particularly if they build on the certification and obtain a bachelor’s degree.
  • American Medical Billing Association (AMBA): Those interested in becoming a Certified Medical Reimbursement Specialist (CMRS) may prefer AMBA’s program. CMRS certification demonstrates knowledge of the ICD9, medical terminology, and insurance claims. CMRS holders build careers in doctor’s and specialty clinics and healthcare billing companies.

Certifications

  • AAPC: Candidates should earn at least an associate degree prior to sitting for the CPB. To take the exam, AAPC membership is required, as well as a $300 fee. The exam consists of 200 questions administered over five hours and 40 minutes; AAPC personnel proctor the test at exam sites located across the country. The questions on the exam are allocated as follows: case analysis (25%), types of insurance (22%), reimbursement and collections (14%), billing (14%), billing regulations (12%), coding (7%), and HIPAA and compliance (5%).

    A 2012 AAPC survey revealed some type of certification was required for more than half of the positions held by AAPC members.

  • AHIMA: To be eligible to sit for AHIMA’s RHIT certification, the candidate must have associate-level academic credentials from an HIM accredited program. Depending on membership status, the exam costs between $229 and $299. Candidates sit for this 3.5-hour, 150-question exam in one of many test centers located across the U.S. Exam questions are split as follows: data analysis and management (20%); coding (18%); compliance (16%); information technology (12%); quality (12%); legal (11%); and revenue cycle (11%).

    Precise employment data for this certificate is not available. However, as the Bureau of Labor Statistics notes, “employers prefer to hire medical records and health information technicians who have professional certification.” In 2010, the BLS reported these professionals earned a median annual salary of $32,350.

  • AMBA: The only prerequisites for taking the CMRS examination are a high school diploma and current membership in the AMBA. The exam fee is $325. Candidates sitting for the CMRS exam do so online, and may take up to 45 days to complete it. The exam is divided into 16 sections: medical terminology; anatomy and physiology; information technology; web and information technology; ICD-9-CM coding; CPT-4 coding; clearinghouses; CMS 1500; insurance; insurance carriers; acronyms; compliance; fraud and abuse, managed care, general and case study.

According to the BLS, medical records technicians earned a median salary of $32,350 in 2010. Nearly 180,000 people are employed in these positions, and the field is expected to grow 21% through 2020.

Although closely related, each certification program is unique. Carefully research your options to ensure that the credential program in which you choose to invest matches your academic preferences and will ultimately help you reach your professional goals.

Additional Resources

  • What Does a Career In Medical Billing Look Like?

    #1: Where Do Medical Billing Professionals Work? While medical billing is a highly specialized career, professionals in the field work in a variety of settings. Many find positions in offices, away from the action of a hospital, while others work in much more clinical settings. Increasingly, medical billing professionals are being encouraged to work remotely…

  • Curriculum

    CPB Curriculum Competencies The CPB curriculum focuses on seven primary competencies of medical billing: Types of Insurance: Students learn how managed care systems work, and how to distinguish between and work with different commercial (Blue Cross/Blue Shield) and government (Medicare and Medicaid) providers. Other related issues include Medigap, worker’s compensation, and third-party…

  • Exam Prep

    Exam Prep Students preparing for the Certified Professional Biller (CPB) exam need all the practice they can get. Consisting of 200 questions to be correctly answered in 5.66 hours, candidates want to have the answers on the tip of their tongue if they want to pass the test on the first try. To help…

View All Resources