Medical Billing Certification

Certification isn’t a strict requirement, but many medical billing professionals find that having a certification opens up more job opportunities, promotes significant career advancement, and a higher salary.

There are various certifications offered by different organizations.

In this article, we will explore the two major certifying agencies in medical billing.

They include the American Association of Professional Coders (AAPC) and the American Medical Billing Association (AMBA).

AMBA

This professional organization is entirely dedicated to the billing field.

They have been offering their Certified Medical Reimbursement Specialist (CMRS) exam for more than ten years.

Similar to the CPC exam, this is a large and comprehensive examination aimed at testing candidates on all stages of the medical billing process.

To take the exam, you should be a member of AMBA.

Membership costs $99 per year.

The examination includes 16 sections, and covers the following:

• Information Technology and Computers.
• ICD-10-CM Coding.
• Anatomy and Physiology.
• Medical Terminology.
• EDI Transactions and Clearinghouses.
• Web and Information Technology.
• CPT Coding.
• Insurance Carriers.
• CMS 1500 Claim Form.
• Insurance.
• Fraud and Abuse.
• Acronyms/Terms in Healthcare Use.
• Case Studies.
• Compliance and HIPPA.
• General.
• Managed Care.

The exam comprises over 800 questions, and to pass it, students should earn 85% or higher.

Students take it online and should complete it within 45 days from the moment they signed up.

The exam is divided into sections.

After students complete one section, they immediately see their grades.

The overall scores are also available upon completion.

If you fail the test, you can retake it two more times for free with at least 30 days (but not over 60) between the attempts.

The AMBA store has the CMRS study guide available for $199 to help you prepare for the exam.

They recommend that you have at least some experience in billing or a strong practice foundation before you take the exam.

To take this class, you also need a high school diploma or equivalent.

You are allowed—and encouraged—to use the current publications for medical coding during the exam, including the CPT, ICD-10-CM, and HCPCS Level II coding manuals.

After you pass your exam, you will have to maintain your certification.

For this, you are required to complete 15 credits of continuing education per year.

Also, you have to maintain your annual membership.

To earn continuing education credits, you can take classes through AMBA, Cengage, AMA, and other organizations.

The AAPC, Practice Management Institute (PMI), American Health Information Management Association (AHIMA), and Medical Group Management Association (MGMA) allow you to earn half-credit toward your continuing education credits.

AAPC

The American Association of Professional Coders is the largest organization for health information professionals.

Its main focus is medical coding, but they also offer a medical billing certification.

You can earn this certification by completing the Certified Professional Biller exam (CPB™).

This exam tests medical billers on every facet of billing.

This certification is comprehensive and is a well-respected benchmark for health information professionals.

The exam takes five hours and 40 minutes to finish and includes 200 questions, covering:

• Types of insurance.
• Billing.
• Billing regulations.
• Case Studies.
• Coding.
• HIPAA and compliance.
• Reimbursement and collections.

Contrary to the CMRS exam, this test must be completed in one sitting.

Students should have their codebooks, listing ICD-10-CM, and HCPCS codes.

The passing score is 65%.

Similar to the CMRS certification, students must pay the membership fee in the sponsoring organization, AAPC, and complete a particular number of continuing education courses to maintain the certification.

They need 36 continuing education units every two years.

Continuing education is available in the form of online classes, training courses, meetings, seminars, and other types of instruction.