By Cindy Parman, AuntMinnie.com contributing writer

July 19, 2018 -- There's a lot of talk in today's healthcare regulatory environment about the need for "certified" coders and the potential benefits to healthcare entities that employ individuals who are credentialed in various aspects of coding, billing, and compliance. Because there are a number of credentialing options available, it is important to understand some basics of medical coding and the certification process.

This article presents some questions for an individual or organization to consider when selecting a certifying organization and credential.

Is there national recognition of the credential?

To meet the requirements for a nationally recognized certification, a number of criteria must be met. First, the organization that will develop, oversee, and administer the examination generally contracts with a company that specializes in the construction of certification programs. These organizations include individuals known as psychometricians, who specialize in scientific test development.

Cindy Parman
Cindy Parman of Coding Strategies.

According to one definition of psychometrics, "Due to the potential impact of testing on everyone's lives, the practice of testing is also controversial and our society depends on the efforts of psychometricians to continue striving for more valid, reliable, and efficient tests."

This organization then determines the optimal number of test questions, the categories of items to be tested (e.g., for medical coding, number of diagnosis questions, current procedural terminology questions, etc.) and initiates the gathering of test questions and scenarios.

Once this process has begun, the certifying organization assembles a panel of subject matter experts (SMEs) from across the industry or specialty who review the questions, add detractors or distractors (the wrong answers in multiple choice questions), and verify the correct response with authoritative coding guidance (depending upon the question database used, this verification may include publication, page number, etc.). Any nationally recognized certification must be prepared to survive a legal challenge by documenting the authoritative source for the correct answer.

The psychometric firm will typically oversee the creation of the final examination, which will then be subjected to a beta test environment. The results of the beta test must be analyzed prior to release of the certification examination to the general public. This subsequent release should occur within a short period of time after the beta testing period. In general, the firm specializing in certification programs will monitor the testing process for a specified period of time to ensure the validity of the examination and credentialing process.

If an inquiry into the structure of the examination indicates that a single individual or single company has constructed the exam based on its personal coding or billing philosophy, more information may be necessary before the coder pays for a questionable "certification." Another important question involves the length of time the certifying agency has been in operation, as well as the number of individuals who currently possess the credential.

Comprehensive coding certification

If a general coding certification is required, this means the individual must exhibit comprehension and knowledge of all medical specialties and not be limited to procedures associated with one specialty. A comprehensive certification in medical coding is currently available from two sources: the American Academy of Professional Coders (AAPC) and the American Health Information Management Association (AHIMA).

The AAPC offers the following comprehensive coding credentials:

  • Certified Professional Coder (CPC)
  • Certified Outpatient Coder -- Hospital (COC)
  • Certified Professional Coder -- Payor (CPC-P)
  • Multiple specialty certifications

The AHIMA offers the following coding-specific certifications:

  • Certified Coding Associate (CCA) entry-level certification
  • Certified Coding Specialist (CCS)
  • Certified Coding Specialist -- Physician-Based (CCS-P)

There are distinct differences between each of the certification exams listed above; therefore, the exam requirements and content should be carefully reviewed prior to making a decision.

Radiology specialty certification

In addition to the nationally recognized certifications, there are two radiology-specific certifications offered by the Radiology Coding Certification Board (RCCB):

  • Radiology Certified Coder (RCC)
  • Radiology Certified Coder -- Interventional Radiology (RCCIR)

There are other radiology-specific certifications on the market; however, they are not managed by a separate and distinct not-for-profit examination board.

Who recognizes or accepts the certification?

This is potentially the most critical element related to the selection of a coding credential -- is it recognized by all providers, payors, peers, and specialty organizations? With the current boom in available certifications, it can be lucrative for a consulting company, billing agency, or enterprising individual to write an exam, charge for the review class or study guide, and award an ATL (any three letters) for the successful completion of its certification examination.

One such enterprising company admitted during a regional specialty conference that its examination was graded on a curve for the first few test dates to ensure that enough candidates successfully acquired the credential. This same group changed some of the questions for each examination session -- reportedly to remove ambiguous material and improve the quality of the test. It is possible that this type of certification would not meet the criteria to be nationally recognized.

It may also be beneficial to contact prospective employers, specialty societies, and other organizations to determine if the credential carries any value with respect to employment or salary. In general, a nationally recognized coding certification may result in an increased salary for the individual who is awarded the credential.

In addition, companies that employ certified coders often advertise this benefit to clients, include employee certification status in their comprehensive compliance program, and may hire certified staff to decrease the initial training time required.

What are the CEU requirements?

A major consideration for individuals who must pay for their certification and ongoing education credits is the availability of products and seminars that contribute to the acquisition of continuing education units (CEUs). It is important that the CEUs be readily available and affordable, and that the presentations or products that qualify be relevant and pertinent to the type of work performed by the certified individual.

When reviewing a potential certification, carefully evaluate the list of CEU opportunities. Can CEUs be obtained through a variety of vendors and media? Or are all available CEUs obtained only through the entity that sponsors the certification? If there are a number of vendors listed for CEUs, it may be prudent to verify that these vendors support the certifying organization and know their name is associated with the certifying entity.

Are there membership benefits?

In addition to the accrual of letters after your name, what are the other benefits of certification? Does the sponsor for the credential provide a newsletter, offer career placement opportunities, maintain a directory for networking, support local affiliates, or hold national conferences? If there are none of these added values, what are the benefits of participating in the organization?

In addition, some credentialing organizations are "for-profit" while others are "not-for-profit." A not-for-profit organization is an entity with the primary objective of supporting an issue or public concern for noncommercial purposes, without concern for monetary gain. While not-for-profit organizations make money and pay taxes, their purpose is to use the funds generated for member benefits. In contrast, a for-profit organization is a business that will return a profit to the owner or stakeholders.

Summary

A number of organizations offer both general and specialty certificates, but as in all things, caveat emptor (buyer beware!). Consider the following points:

  • Determine the best certification for you.
  • Do your homework and investigate the certification(s) available. What are the benefits, costs, and continuing education requirements? How was the examination developed, and is it legally defensible?
  • What's in it for you? Consider the member services and benefits to determine if the cost of the certification has a good return on the investment. Do you want a vote in a not-for-profit organization, or would you prefer to credential with an organization that profits from the certification process?

In addition, talk to medical coders who have the credential. What problems have they encountered? What are the benefits to certification? What would they do differently? What has changed for them since they acquired the certification (i.e., salary increase, recognition, promotion)?

The certification process is expensive, regardless of whether the examination fees, CEUs, and other charges are paid by an employer or the certified individual. The result of such an investment should be a nationally recognized, credible certification that is accepted in the medical community, contributes to the career goals of the certified individual, and adds value to the employing organization.

Cindy Parman is executive vice president of Coding Strategies and Revenue Cycle. Her areas of expertise include physician and hospital medical coding and multispecialty coding audits. In addition, she is a highly sought after national speaker on a variety of coding and compliance topics.

The comments and observations expressed are those of the author and do not necessarily reflect the opinions of AuntMinnie.com.


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