What Are The Requirements For Medical Billing And Coding Certification? (2024)

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For medical billers and coders, professional certifications can prove to employers that you have invested the time and energy required to become proficient in your field. While not always required, these certifications can offer a higher earning potential and boost your resume.

If you are planning to earn certifications in the medical billing and coding field, you should first understand their requirements. This article explores common requirements for medical billing and coding certifications.

What Are Medical Billing and Coding Certifications?

Medical billing and coding certifications are credentials earned by passing exams to demonstrate you have mastered a set of skills specific to the medical billing and coding field.

Although these certifications are often voluntary, they are sometimes required or highly recommended when applying for jobs. To prepare for your certification exam of choice, consider a medical billing and coding certification online training program.

Below we list a few popular medical billing and coding certifications and the requirements for each.

Medical Billing and Coding Certification Requirements

Certified Coding Associate (CCA)®

Cost: This test costs $199 for American Health Information Management Association (AHIMA) members and $299 for nonmembers.

Time to Completion: You have two hours to complete the certification exam. The exam contains 115 questions.

Requirements for Certification: A high school diploma or the equivalent is required. It is also recommended that candidates have at least six months of medical coding experience or complete an AHIMA coding program (or another equivalent program).

Test-takers are required to bring their ICD-10-CM, ICD-10-PCS and CPT® code books to the exam. AHIMA lists the approved versions of these code books on its website.

Applicable Jobs: This certification can help you get a job at a hospital or doctor’s office. The CCA is an excellent entry-level certification for those in the early stages of their medical billing and coding careers.

Certified Coding Specialist (CCS)®

Cost: This exam costs $299 for AHIMA members and $399 for nonmembers.

Time to Completion: This exam takes up to four hours to complete and includes between 115 and 140 questions.

Requirements for Certification: AHIMA recommends that you have several years of experience in coding, a CCA or equivalent certification and at least a year of coding experience before taking this exam.

It is also recommended to have completed courses in anatomy and physiology, pharmacology, medical terminology, reimbursem*nt methodology and pathophysiology.

Applicable Jobs: This certification is more specialized than the CCA credential. Therefore, it is a natural next step for those who are already experienced in the medical coding and billing field. However, it may help you in hospital jobs that specifically look at coding data used to get reimbursem*nt from insurance companies and government-funded programs.

Certified Coding Specialist – Physician-Based (CCS-P)®

Cost: This exam costs $299 for AHIMA members and $399 for nonmembers.

Certified Professional Coder (CPC)®

Cost: This exam costs $349 for one attempt or $449 for two attempts.

Time to Completion: This test takes up to four hours and features 100 multiple-choice questions.

Requirements for Certification: To take the CPC test, you must have an American Academy of Professional Coders (AACP) membership.

In addition, it is required that you understand anatomy, pathophysiology and medical terminology. You can learn this material by taking courses or gaining experience in the medical or medical coding field.

You must answer 70% of exam questions correctly to pass. When you pass the CPC exam, you will be awarded a CPC-A credential, which indicates apprenticeship. You must then complete two years of experience on the job or take an online practicode course before being awarded full CPC certification.

Applicable Jobs: The CPC is a highly sought-after certification and can help your chances at most relevant positions. Because the CPC is one of the most acknowledged credentials in the medical billing and coding field, it can be helpful in most career applications, whether at a hospital or a private practice.

Certified Outpatient Coder (COC)®

Cost: This exam costs $349 for one attempt or $449 for two attempts.

Time to Completion: This exam takes up to four hours, containing 100 multiple-choice questions.

Requirements for Certification: The COC requires you to have AACP membership, have two years of experience coding and complete 36 continuing education units (CEUs) every two years. Similarly to the CPC, passing the COC exam awards you with a COC-A credential until you can prove two years of experience on the job.

Applicable Jobs: Relevant work environments for this certification include hospital emergency departments, outpatient clinics and centers, radiology departments and ambulatory surgery centers.

Certified Inpatient Coder (CIC)®

Cost: This exam costs $349 for one attempt or $449 for two attempts.

Time to Completion: This exam takes up to 4 hours, and there are 47 questions: 40 multiple-choice questions and seven fill-in-the-blank questions.

Requirements for Certification: AACP membership is required to take the CIC certification exam. In addition, test-takers should be educated in inpatient coding, reimbursem*nt fundamentals and anatomy and medical terminology.

CICs must complete 36 CEUs every two years to maintain certification.

Applicable Jobs: The CIC credential applies to jobs centered around hospital and facility inpatient coding. Potential work environments for CICs include general hospitals, skilled nursing facilities, critical access hospitals and inpatient rehab facilities.

Certified Risk Adjustment Coder (CRC)®

Cost: This exam costs $349 for one attempt or $449 for two attempts.

Time to Completion: This proctored exam takes up to four hours, and there are 100 multiple-choice questions.

Requirements for Certification: The CRC exam requires an AACP membership. AACP advises that CRC candidates have prior experience and understanding of CRC training. CRCs must complete 36 CEUs every two years to maintain certification.

Applicable Jobs: This credential validates your skills writing precise risk scores for patients with high-risk diseases, demonstrating a deep knowledge of clinical documentation and reporting of diagnoses.

Certified Medical Coder (CMC)®

Cost: The exam and its accompanying medical billing and coding online course costs $1,250.

Time to Completion: This proctored exam takes up to six hours.

Requirements for Certification: You should have at least a year of experience as an outpatient medical coder before taking the CMC exam. If you have yet to complete this experience, taking a Principles of Coding course is highly recommended.

You must also have up-to-date editions of the CPT, HCPCS and ICD-10-CM code books and a medical dictionary throughout the course and on the day you take the exam.

Applicable Jobs: This certification applies to outpatient claims work, especially in working with claim submissions and accurate payments.

Certified Billing and Coding Specialist (CBCS)

Cost: The cost of this exam is $109.

Time to Completion: This exam takes up to three hours and has 100 scored questions.

Requirements for Certification: The exam requires you to have a high school diploma or the equivalent. Test-takers must have completed medical billing and coding training or education within the last five years or have worked within the field for at least a year (within the previous three years). They are also required to have the code books CPT, ICD-10-CM and HCPCS for the CBCS exam.

Applicable Jobs: This certification can help you get jobs at hospitals, doctors’ offices, nursing homes and other medical facilities.

Certified Medical Reimbursem*nt Specialist (CMRS)®

Cost: The cost of this exam is $325.

Time to Completion: You will have 45 days to access the exam to complete it. It is an open-book examination that includes 710 questions.

Requirements for Certification: To take this exam, you must be an American Medical Billing Association (AMBA) member. You are also required to have a high school diploma or the educational equivalent.

AMBA recommends that test-takers have current editions of the HCPCS, CPT and ICD-10 code books. It is also recommended that candidates have experience and knowledge in the medical billing field.

Applicable Jobs: Because this examination is the longest-standing and most detailed for medical billers, it is one of the most prestigious credentials you can earn as a medical records specialist. This credential demonstrates knowledge and skills in handling the claims payment process in the medical field.

As an expert in the field of medical billing and coding, I bring firsthand knowledge and expertise to guide individuals through the complex landscape of professional certifications in this domain. Having worked extensively in the medical coding and billing field, I understand the significance of certifications in demonstrating proficiency to potential employers. Let's delve into the details of the concepts mentioned in the provided article.

Medical Billing and Coding Certifications Overview:

Medical billing and coding certifications serve as tangible evidence of one's mastery in specific skills related to the field. While not always mandatory, these certifications enhance earning potential and bolster a resume. To assist in your certification journey, online training programs are recommended.

Here's a breakdown of some prominent certifications along with their requirements:

Certified Coding Associate (CCA)®:
- Cost: $199 for AHIMA members, $299 for nonmembers.
- Time to Completion: Two hours.
- Requirements: High school diploma or equivalent, six months of medical coding experience or completion of an AHIMA coding program.
- Applicable Jobs: Entry-level certification for hospital or doctor’s office positions.
Certified Coding Specialist (CCS)®:
- Cost: $299 for AHIMA members, $399 for nonmembers.
- Time to Completion: Up to four hours.
- Requirements: Several years of coding experience, CCA or equivalent certification, at least one year of coding experience, courses in relevant subjects.
- Applicable Jobs: Specialized certification for experienced professionals, useful in hospital jobs related to coding data for reimbursem*nt.
Certified Coding Specialist – Physician-Based (CCS-P)®:
- Cost: $299 for AHIMA members, $399 for nonmembers.
- Time to Completion: Up to four hours.
- Requirements: Education in specific subjects, one year of coding experience, or alternative pathways.
- Applicable Jobs: Specific to physician care, suitable for doctor’s offices or specialty clinics.
Certified Professional Coder (CPC)®:
- Cost: $349 for one attempt, $449 for two attempts.
- Time to Completion: Up to four hours.
- Requirements: AACP membership, understanding of anatomy, pathophysiology, and medical terminology.
- Applicable Jobs: Highly sought-after, beneficial in various positions within medical billing and coding.
Certified Outpatient Coder (COC)®:
- Cost: $349 for one attempt, $449 for two attempts.
- Time to Completion: Up to four hours.
- Requirements: AACP membership, two years of coding experience, and continuing education.
- Applicable Jobs: Relevant for hospital emergency departments, outpatient clinics, radiology departments, and ambulatory surgery centers.
Certified Inpatient Coder (CIC)®:
- Cost: $349 for one attempt, $449 for two attempts.
- Time to Completion: Up to four hours.
- Requirements: AACP membership, education in inpatient coding, and ongoing education requirements.
- Applicable Jobs: Focused on hospital and facility inpatient coding.
Certified Risk Adjustment Coder (CRC)®:
- Cost: $349 for one attempt, $449 for two attempts.
- Time to Completion: Up to four hours.
- Requirements: AACP membership, prior experience and understanding of CRC training.
- Applicable Jobs: Validates skills in writing risk scores for patients with high-risk diseases.
Certified Medical Coder (CMC)®:
- Cost: Exam and online course cost $1,250.
- Time to Completion: Up to six hours.
- Requirements: At least one year of outpatient medical coding experience, up-to-date code books, and a medical dictionary.
- Applicable Jobs: Suitable for outpatient claims work, emphasizing claim submissions and accurate payments.
Certified Billing and Coding Specialist (CBCS):
- Cost: $109.
- Time to Completion: Up to three hours.
- Requirements: High school diploma or equivalent, recent medical billing and coding training or at least a year of field experience.
- Applicable Jobs: Helpful for securing positions in hospitals, doctors’ offices, nursing homes, and other medical facilities.
Certified Medical Reimbursem*nt Specialist (CMRS)®:
- Cost: $325.
- Time to Completion: 45 days to access the exam.
- Requirements: AMBA membership, high school diploma or equivalent, current editions of code books, and experience in the medical billing field.
- Applicable Jobs: Prestigious credential demonstrating expertise in handling claims payment processes.

These certifications cater to various career levels and specialties within the medical billing and coding field, providing individuals with targeted pathways to advance their careers.