Align Your Credentials with Current Health Care Trends

AAPC offers CPC-H®, CPMA®, and CPCOTM credentials to meet today’s coding needs.

By Michelle A. Dick

A Certified Professional Coder (CPC®) is the base credential offered at AAPC. It signifies expertise in coding of services, procedures, and diagnosis of medical claims. It demonstrates the professional is proficient in coding rules and regulations, is current on new changes, and is committed to following a code of ethics. In short, a CPC® raises the bar for the medical coding industry.

Certified Professional Compliance Officer - CPCO

To achieve this level of professionalism, a CPC® must pass a coding certification examination administered by AAPC and have at least two years of hands-on coding experience. Examinations test knowledge of CPT®, HCPCS Level II procedure and supply, and ICD-9-CM diagnosis codes used for billing professional medical services to insurance companies. In exchange for this level of dedication, most employers recognize and prefer hiring CPCs®. The average salary is 20 percent higher for a CPC® than for a non-certified coder, according to AAPC’s annual salary surveys.

Although earning core certification opens the door into the coding world, it doesn’t always mean your coding education is complete. Because many credentialed coders have an ongoing thirst for coding excellence, AAPC has developed additional credentials which allow coders to stay current with today’s coding trends. And with today’s regulatory changes, additional credentials are attractive to employers, and sometimes even necessary.

Coding Changes Call for Specialized Expertise

Freda Brinson, CPC, CPC-H, CEMC, compliance auditor for corporate compliance at St. Joseph’s/Candler Health System, obtained her second credential, Certified Professional Coder – Hospital Outpatient (CPC-H®), in 1998. At the time, multiple certifications were uncommon. “I do not think there was any industry trend,” Brinson said. “As a matter of fact, I was the only double certified coder in the area.” Times have changed, though, and multiple certifications are more common.

“Not only does certification show you care about your job, it also shows you are serious about your profession and continuing education. Health care has never changed as fast and as often as it is now. Being certified and involved with an organization such as AAPC proves your commitment,” Brinson said.

Today’s health care trends show a need for greater expertise in:

  • outpatient vs. inpatient coding, as private practices merge with hospitals to cut costs
  • auditing electronic health records (EHRs), as paper claims decrease and electronic transactions increase
  • fraud and waste in health care, as the government increases regulatory enforcement

The credentials CPC-H®, Certified Professional Medical Auditor (CPMA®), and Certified Professional Compliance Officer (CPCOTM) can prove your worth in these emerging health care areas.

Coding Moves to More Outpatient Services

In this ever-changing world of health care, physicians are looking for cost-effective solutions that will allow them to continue practicing medicine. One solution many physicians have found to be advantageous is working under a hospital’s umbrella. Physicians receive the administrative and financial support of the larger organization, and the hospital, in turn, gains direct access to the physicians and their patients. For these reasons, hospital acquisitions of physician practices have been rapidly increasing in the last three years. The CPC-H® credential prepares a coder for this growing trend.
CPC-H® Prepares You for Hospital Coding

Dorothy Steed, CPC-H, CPC-I, CEMC, CFPC, CPMA, CPUM, CPUR, CPHM, CCS-P, CHCC, ACS-OP, RCC, RMC, PCS, FCS, CPAR, an independent consultant and educator, earned her CPC-H® to demonstrate her expertise in the hospital side of coding and to keep up with the increased number of physician practice acquisitions.

“With the current trend of hospitals purchasing physician practices, my experience has been invaluable in working with both entities as well as assisting physician coders who may need to prepare for the hospital world,” Steed said.

For Brinson, too, “being certified in the hospital outpatient side was important because I felt the credential carried merit when discussing hospital coding issues with various departments, CMS, and other payers.”

Coding compliance analyst/auditor Kevin B. Shields, CPC, CPC-H, CPC-P, CCS, CCS-P, also obtained his CPC-H® because he felt “a hospital certification through AAPC was integral and very relevant” to his job duties.

“There are very few academic programs focused on producing hospital coders,” Shields said. “My first stride in combating that was to gain the certification.”

Since then, he has been an advocate for the CPC-H® by promoting classes, holding review sessions, and becoming an “ad hoc spokesperson for the certification and its importance to career and skill development.”

Coders’ Role Changes with EHR Adoption

The EHR is revolutionizing documentation and reporting in the medical profession; and with recent government support initiatives, EHRs will become more prevalent. The eventual goal of the Obama administration is EHR use in every physician’s office, with data sharing between all—the theory being widespread adoption will cut governmental spending and improve quality of care.

While EHRs do hold promise, there are also well-documented potential problems with EHR use involving templated records, wrong code assignments, and inadequate documentation. As a result, coders will need to verify whether EHR systems are assigning the correct codes to documentation and that Medicare guidelines and other governmental regulations are being met.

According to AAPC’s 2010 quarterly workshop “EMRs—What You Need to Know NOW!” by James M. Taylor, MD, CPC, medical director revenue cycle, Kaiser Permanente, Colo., after an EMR installation, coders transition to a “new paradigm: educator/auditor vs. rescue recovery coders.”
“Using coders in an upstream auditing and educational role was crucial to the success of attaining 95 percent accuracy in coding and claims accuracy in Kaiser Permanente Colorado,” Taylor said.

CPMA Prepares You for an Auditing Role

The CPMA® credential prepares a coder to move into a coder/auditor role. Cindy Cox, CPC, CPMA, a behavioral health and HIV medical coder, realized obtaining the CPMA™ would further her coding education.

“I know, in my career, I have worn multiple ‘hats’ while working for the same organization … and having the additional CPMA® credential is a real plus,” Cox said. “I felt the CPMA® was a necessary credential for me because I do both coding and auditing in my organization.”

In addition to obtaining the CPC-H® credential to achieve accurate claim capture for hospital billing, Steed felt it important to earn the CPMA credential, as well.

“As health care became business focused, I decided it would be advantageous to gain as much knowledge as I could about both entities,” Steed said. “The CPMA has been an added advantage in assisting physicians and hospital staff about industry standards and requirement.”

Government Increases Fraud and Waste Scrutiny

The government sees reducing fraud and waste as the “low-hanging fruit” in reducing health care costs. To tackle these areas of excessive government spending, a proliferation of federally-funded entities has been tasked to scrutinize claims, uncover fraud, and recoup overpayment. As a coder, you should be able to demonstrate an understanding of the key requirements needed to effectively develop, implement, and monitor a health care compliance program for your practice, or to help others in their compliance efforts, based on governmental regulatory guidelines.

CPCO Prepares You for Regulatory Mandates

AAPC has developed the CPCO credential to take your career and practices to the next level in compliance. Health care compliance certification addresses the growing requirements, laws, regulations, rules, and guidelines; it shows an exceptional understanding of how to implement a compliance program.

What’s the difference between earning a CPC® credential and a CPCO?

Christopher Parrella, JD, CHC, CPC, CPCO, of The Health Law Offices of Anthony C. Vitale, says “The CPC deals in a very hyper-technical detailed world of specificity, both clinical and otherwise. A CPCO is tasked with big thinking, risk management in the dynamic world of health care fraud and abuse.”

In other words, the CPCO credential prepares a coder to manage an office compliance program, protecting the physician and the practice.

“The CPCO shows the individual is acutely adept at spotting fraud and abuse issues in terms of a detailed unbundling or CCI violations to much more broad matters such as false claims or payment relationships which could implicate the federal anti-kickback law or Stark law,” said Parrella. “In this enforcement initiative-driven industry of today, a CPC/CPCO speaks from a level of heightened knowledge and hopefully heightened vigilance.”

Credentials Set You Apart from Other Candidates

Credentials are valuable even if they are not requested in the job postings for which you apply. Most auditing and compliance job listings found on the AAPC job board do not specify an auditing or compliance credential. They specify a core coding credential (CPC®, CPC-H®, etc.). With the job market and economy the way it is, taking the initiative to obtain the CPMA® or CPCO credential gives any candidate a clear advantage over other applicants with the same work experience and core credential.

Shields said, “It is more important than ever for coders to embrace how the job market has changed and adapt to those alterations.” This requires “reaching into a variety of settings and work environments to optimize qualifications and broaden labor opportunity.”

“There are always new challenges in the industry, whether it be medical billing and coding challenges, technology, compliance, health care advances, government regulations, and even corporation downsizing, layoffs, reorganizing, and hiring, etc.,” according to Debbie L. Senarighi, CPC, CPC-H, CPC-P, CPMA, physician coder. To prepare herself career-wise for whatever challenge lies ahead, she said, “I want to be the last one standing, or the first one hired. Obtaining AAPC coding credentials paid off for me in all of the above.”

With Credentials, the Sky’s the Limit

With major forces shaping and changing health care, the best way to advance your career is to acquire the skills that will be in demand in the near future through credentialing. As credentials expand, credential holders will demonstrate their specialized capabilities, and specific credentials will become required for positions (similar to the history of the CPC® credential).

Michelle A. Dick is executive editor at AAPC.

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