Why certifications matter when looking for a medical biller
6/1/2022
Medical billers and coders are critical to revenue cycle management, thus having a skilled and high-performing workforce is critical to running your medical practice smoothly and successfully. Medical billers submit and follow up on claims with insurance companies in order to get paid for services provided by a healthcare provider, whereas medical coders translate medical reports such as diagnoses, medications, and procedures into codes that insurance companies use to reimburse for the performed services.
Medical billers and coders should have the necessary skills and knowledge in their fields, such as understanding how to read medical records and being familiar with the major code sets, among other things, in order to be more efficient with their responsibilities, which are critical to medical organizations' financial resources. Hiring billers and coders who are not only highly trained but also certified by specific reputable organizations is one approach to verify their credibility, such as the ones below.
American Medical Billing Association (AMBA)
The Certified Medical Reimbursement Specialist (CMRS) Certification, offered by the American Medical Billing Association (AMBA), is the longest-running and most comprehensive exam for professional medical billers. This is one of the best medical billing and coding certifications. Those who pass the exam and earn the certification are acknowledged as knowledgeable and skilled in the industry, and they are dedicated to promoting ethical and professional medical billing practices.
The Certified Medical Coding Specialist (CMCS) is a more modern certification demonstrating an identical set of skills & knowledge.
American Academy of Professional Coders
The American Academy of Professional Coders (AAPC) offers a certification for medical billers called Certified Professional Biller (CPB). This certification ensures that a biller has knowledge of various types of insurance plans and payment policies; Local Coverage Determinations (LCDs), and National Coverage Determinations (NCDs) for successful claim submissions; knowledge of CPT, ICD-10-CM, and HCPCS Level II coding guidelines; understanding of the life cycle of a medical billing claim.
Medical coder certificates from the American Academy of Professional Coders (AAPC) are nationally recognized and considered the gold standard in the healthcare business. They provide a variety of certificates for people of varying levels of expertise and specialties:
• Certified Professional Coder (CPC)
When it comes to recruiting medical coders, the Certified Professional Coder (CPC-A) qualification is highly regarded by physician offices around the country. This is a golden standard certification that demonstrates a biller’s ability to interpret medical records and superbills, while also his/her awareness of various combinations of procedure codes that cannot be reported together
• Certified Family Practice Coder (CFPC)
CFPC certification demonstrates expertise and experience in coding general medicine/family practice services and procedures, such as venipunctures, injections, EKGs, lesion excisions, foreign body removals, fracture care, etc.
American Health Information Management Association
The Certified Coding Associate (CCA) certification granted by the American Health Information Management Association (AHIMA) defines that the holder is competent across all coding settings, including hospitals and physician practices, and commitment to the profession.
There are many certifications that you can use to measure the expertise of your outsourced medical biller, but the ones described above are the most popular.
If you are still hesitant about whether to work with an experienced yet expensive professional or with a cheap amateur, below are the top-5 benefits of hiring a certified biller:
• Small claim denial rate. Since professional billers are familiar with CPT and ICD-10 combinations that cannot be reported together, they are more likely to identify “unclean” claims before submission
• Security. Certified billers and coders are more likely to comply with HIPAA requirements because knowing those is critical for passing the certification exams
• Rapidness. Expertise facilitates claim submission & collection processes
• Compliance with industry updates. Certified medical billing professionals always comply with the new payer reimbursement policies. Hence, they are always keen to adjust & facilitate the processes accordingly
• Specialty-specific support. Certified billing professionals understand the unique requirements of your specialty and work on denials in a unique matter
At WCH Service Bureau, we are proud to have gathered a team of professionals that can Help you facilitate all the above-mentioned indications. Here is a list of certifications our employees currently have:
• Certified Professional Coder (CPC)
• Certified Outpatient Coder (COC)
• Certified Professional Compliance Officer (CPCO)
• Certified Professional Medical Auditor (CPMA)
• Certified Family Practice Coder (CFPC)
• Certified Medical Reimbursement Specialist (CMRS)
• Certified Medical Coding Specialist (CMCS)
• Certified Urology Coder (CUC)
Ready to boost your medical practice revenue? Contact us!
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