Maybe you’ve been working in medical billing and coding for years and you’ve grown to love it – everything from hunting down and finding that specific, perfect code to successfully appeal a denied reimbursement claim with your office’s toughest insurance company. As the industry has evolved, you’ve adapted with it, anticipating code set changes and maybe even making a few suggestions that shaped your office’s workflow. You have a firm grasp on the "big picture" of medical billing and coding, and you’re ready for more – more challenges, more responsibilities, and while you’re at it, more pay.
But what more is there? Are there really ways for medical billers and coders to "dig their way out of the trenches" and assume a role that involves more than just coding, billing, and the various administrative tasks that go along with them? The answer is yes. If you’re an experienced, knowledgeable, certified, and highly competent medical biller and coder, you have many opportunities to advance within your field or into a closely related career, such as instruction, management, or auditing.
CPC-I: Certified Professional Coder – Instructor
The American Association of Professional Coders (AAPC) offers a CPC-I certification specifically designed for those who wish to teach medical billing and coding professionally. This certification is only designed for those that have an expert-level understanding of the field.
CPC-I Requirements:
- An AAPC membership.
- An AAPC certification, such as CPC or CPC-H.
- Good standing with the AAPC. This is accomplished by completing the correct number of Continuing Education Units for your certification(s) every two years.
- At least five years of professional coding experience.
Next, you’ll need to fill out and submit an instructor application to the AAPC. This is a one-page form detailing your personal information, educational experience, certification dates, coding experience and instructional experience. You must include two letters of recommendation along with your application.
After the AAPC verifies your personal qualifications, you’ll be invited to a Professional Medical Coding Instructor (PMCC) workshop. The workshop includes various presentations and a written examination gauging your coding knowledge. The course is divided into five separate modules:
- Teaching Through the Guidelines
- Classroom Dynamics
- Adult Learning
- Marketing
- The PMCC Instructor Program
The program is designed to teach you how to be an instructor and run a medical billing and coding learning center. Early in the course, you’ll learn how to teach the guidelines of the Healthcare Common Procedure Coding System (HCPCS), Current Procedural Terminology (CPT), and ICD-9-CM coding manuals. Later, the emphasis shifts to developing your presentation skills, creating a business plan, and advertising your services.
To receive your CPC-I certification, you must pass a 50-question multiple choice exam with a score of 70% or higher. You must also conduct a 15-minute presentation, which will be evaluated by your peers.
CPMA: Certified Professional Medical Auditor
Patient welfare is always a top priority. However, the quality of a facility’s revenue cycles is often second on the list. To ensure compliance with industry guidelines, bolster quarterly profits, and keep things running smoothly, medical offices rely on medical auditors. With the proper auditing credentials from the AAPC, you can step into this role at your current medical practice. You may even find yourself with more lucrative offers from other medical offices that are desperate for a certified auditor to improve their revenue cycles.
The AAPC offers a two-day CPMA preparation class to prepare you for the CPMA exam. The AAPC offers online practice exams you can take to make sure you are ready for the real thing. Successful completion of the class and exam will earn you the titles of Certified Professional Medical Auditor and National Alliance of Medical Auditing Specialist. All of this will prepare you for a career of auditing charts, preventing reimbursement and documentation errors, performing risk analysis, and employing various statistical sampling methodologies, all with the goal of improving the daily operations of your medical practice.
CPMA Requirements:
To receive the CPMA credentials, you must pass the CPMA exam, which tests your knowledge of auditing, evaluation and management, regulatory and compliance issues, and basic coding, and modifiers. The AAPC recommends that applicants have an associate degree and two or more years of experience specific to medical auditing, though these are not firm requirements.
The CPMA exam itself consists of 150 questions and lasts for 5 hours, 40 minutes. The exam is broken down into the following topics:
- Medical Record Auditing Abstraction – 52 questions
- Coding and Documentation Compliance Guidelines – 32 questions
- Medical Record Standards and Documentation Guidelines – 26 questions
- Coding and Reimbursement Concepts – 20 questions
- Statistical Sampling Methodologies and Scope – 11 questions
- Communication and Risk Analysis – 9 questions
Most of the questions on the CPMA exam are multiple-choice. However, approximately half of the Medical Record Auditing Abstraction section will require you to audit around 20 actual healthcare cases.
CPCO – Certified Professional Compliance Officer
To maintain licensure, professional good-standing, and a satisfied base of clients, healthcare facilities must obey industry regulations, rules, laws, standards, and guidelines. In short, they must remain compliant. Healthcare providers rely on compliance officers to ensure that this happens. As a compliance officer, you’ll develop, implement, assess, and monitor your practice’s healthcare compliance program according to industry and governmental regulatory guidelines.
The AAPC offers a CPCO certification that will allow you to work as a medical compliance officer. The CPCO certification is a relatively new one, brought about by new legislation entitled the Patient Protection and Affordable Care Act (PPACA) of 2010. This act makes compliance programs mandatory for healthcare facilities. These new compliance programs will require leaders, and you may be one of those individuals.
CPCO Requirements:
You must pass the CPCO exam. This is a difficult, high-level exam that the AAPC only recommends to those that have an associate degree and a few years of experience in medical compliance programs. These are only recommendations, however, and not firm requirements. The AAPC offers a study guide and an online practice exam to help you prepare for the real exam.
The CPCO exam includes 150 multiple choice questions and lasts for five hours, 40 minutes. It includes questions on a wide variety of topics, including:
- Regulations and Laws – 36 questions
- OIG Compliance Program Guidance for Physicians and Small Group Practices – 33 questions
- Risk Areas – 28 questions
- Abuse and Fraud Laws – 20 questions
- Investigations Process and Audits – 13 questions
- Healthcare Compliance Program History – 7 questions
- References and Resources – 5 questions
- OIG Supplemental Compliance Program Guidance for Hospitals – 4 questions
- Compliance Program Guidance for Clinical Laboratories and Third Party Billing Companies – 4 questions
About our expert. Jan Jacobs has worked in medical offices since the early 1980's. Ms. Jacobs has worked for M.D.'s and D.O.'s in primary care and specialty care. She is employed as a senior medical biller and has been at her current job for nearly 10 years, where she uses three different billing systems.
