Medical billing & coding accuracy is highly important to healthcare organizations,
and has an impact on revenues of physician's clinic. Physicians who give preference
to certified billers and coders are aware that the field of reimbursement demands
the personnel to be updated with current regulations. In fact, certification has
become an implicit industry standard.
Most of the billers and coders in our organization have got certifications like
CPC, CCS, CPAT. Lets see how these certifications give our billers ascendancy over
Certified Professional Coder (CPC)
A Certified Professional Coder (CPC) must pass a coding certification examination
sponsored by the American Academy of Professional Coders. The examination consists
of questions regarding the correct application of CPT, HCPCS procedure and supply
codes and ICD-9-CM diagnosis codes used for billing professional medical services
to insurance companies. A CPC must have at least two years coding experience and
maintain yearly renewal and CEU requirements.
These qualifications make the CPC certified resource helpful in applying appropriate
codes to your claims, sometimes these coders could also help your clinic prevent
unintentional Insurance abuse and save you a lot of trouble.
Our CPC certified coders abilities include:
- Proficiency in adjudicating claims for accurate medical
coding for diagnoses, procedures and services in physician-based settings,
- Proficiency across a wide range of services, which
include evaluation and management, anesthesia, surgical services, radiology, pathology
- Sound knowledge of medical coding rules and regulations
including compliance and reimbursement. A trained medical coding professional can
better handle issues such as medical necessity, claims denials, bundling issues
and charge capture
- Knowing how to integrate medical coding and reimbursement
rule changes into a practice's reimbursement processes
- Knowledge of anatomy, physiology and medical terminology
necessary to correctly code provider diagnosis and services.
These coders come in handy when healthcare regulations are changing and their application
in your clinic needs to be verified. These coders sometime even offer services as
consultants and are useful in setting up processes.
The CCS certification is the more advanced of two available medical records coding
certifications. The first certification, the Certified Coding Associate (CCA), covers
basic coding terminology and procedures, while the CCS identifies more advanced
medical coders. CCS coders possess advanced skills in International Classification
of Diseases, 9th Edition; Clinical Modification (ICD-9-CM); and Current Procedural
Terminology (CPT) coding systems and possess advanced knowledge of medical terminology,
disease processes, and pharmacology.
Our CCSs certified coders are skilled in classifying medical data from patient records.
These coding practitioners:
- Review patients' records and assign numeric codes for
each diagnosis and procedure
- Possess expertise in the ICD-9-CM and CPT coding systems
- Are knowledgeable about medical terminology, disease
processes, and pharmacology.
These coders could be used in hospital systems where the complexity is high and
the coding department of the hospital is looking to streamline their workflow.
Certified Medical Reimbursement Specialist (CMRS) is a voluntary national credential
that was created specifically for the medical billing professional. The American
Medical Billing Association (AMBA) has been providing this industry certification
and designation for nearly a decade. The CMRS designation is awarded by the Certifying
Board of the American Medical Billing Association (CBAMBA) after an exam. The goal
is to provide a professional certification that upholds a high ethical standard
of knowledge that recognizes the competency of a certificant. Skills of Certified
Medical Reimbursement Specialists.
- Certified Medical Reimbursement Specialists (CMRS)
are skilled in facilitating the claims paying process from the time a service is
rendered by a health care provider until the balance is paid.
- The CMRS is knowledgeable in ICD9, CPT4 and HCPCS Coding,
Medical Terminology, Insurance claims and billing, appeals and denials, fraud and
abuse, HIPAA, OIG Compliance, information and web technology, reimbursement, and
CMRS Billers play a critical role in a health care provider's daily business operation.
So while recruiting billers for your practice you can consider billers in our association
who are certified with CMRS and will help you to improve your practice's collections.