Certification Needed to Work in Medical Billing

Often, people asked whether or not a medical biller is required to be certified in order to be a medical biller.

While certification is not required yet, there are some very good reasons why one might want to obtain certification.

The main purpose of certification is to promote ethical and professional Medical Billing through certification of qualified individuals by formally recognizing proficiency demonstrated by having passed an exam, encouraging continued professional and personal best development and providing a national standard assessment based on industry knowledge. Certification demonstrates to physicians, employers and others that you have taken proactive steps to advance your education, knowledge and skills.

Currently, there is no Federal requirement for certification, however, the state of New Jersey does require third party billers to comply with their "certification" process.

At some point, as defined by the Health and Human Services Secretary (Secretary), billers will be required to register with the state and the Secretary under Section 6503 of the Affordable Care Act.

provide that any agent, clearinghouse, or other alternate payee (as defined by the Secretary) that submits claims on behalf of a health care provider must register with the State and the Secretary in a form and manner specified by the Secretary
For now, billers can safely process claims without registration or certification, unless you bill for healthcare providers in the state of New Jersey.

Being required to obtain certification and wanting to obtain certification are two very different things -- many billers want to get certified to demonstrate their proficiency and professionalism to doctors and other healthcare providers. It demonstrates commitment and dedication in providing the highest standards possible in Claims Management and Medical Billing.

Certification typically requires continued education to maintain the credential and demonstrates to others that you will continue your education process by taking steps to improve your value to the industry and the doctors you work with.

More and more physicians and other healthcare providers are looking for certified professionals that understand regulatory and business issues that affect their practices. Certified billers typically have the knowledge, skills and confidence to be more effective in increasing revenue, preventing fraud and abuse and researching and finding information that helps practices succeed in today's environment and economy. As healthcare providers and doctors begin to require certification from employees that expect a pay raise, more billers will become certified and eventually, it will become the standard for our industry.

To learn more about NJ State Banking and Insurance requirements for Third Party Billers,

You can read the Affordable Care Act (specifically see page 716) for more information on HHS requirements

Cyndee Weston is a speaker, author, trainer, and embraces finding ways to bring medical billers together through the American Medical Billing Association where she serves as Executive Director. She has been instrumental in the development and of medical billing certification. Weston is a reimbursement expert with over 30 years of billing, compliance and coding experience. Particularly, she has substantial experience in identifying practice cash-flow leaks and in implementing policies that resolve issues affecting reimbursement. Weston holds one billing and two coding certifications.