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 others.

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 and medicine
  • 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.

CCS certification:

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 much more.

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.