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I'm very thankful for Portiva who I know is looking after my practice while I'm gone the virtual assistants can manage prescription refills, documents they can triage patients and just kind of answer administrative questions and they can handle a lot on their own. But also, they're very good about contacting me if there's any emergency or anything I need to attend to. So I'm very thankful for Portiva they can help almost any provider almost anywhere and it really allows for some good work-life balance as I'm getting to experience right now at my family farm so I'm very thankful for Portiva and I'm very happy to use their services"

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Board Certified Family Medicine Physician

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The Power of Certified Medical Billing and Coding Certifications

Frightened, shocked doctor looks at a tablet with an open mouth and big eyes. Yellow backgroundMedical billing and medical coding turn a patient encounter into the languages that healthcare professionals use for classifying medical data, normally for insurance claims submission and reimbursement. Medical coding and medical billing are separate procedures, but both are essential for medical providers to receive payment for healthcare services. Medical coding is all about extracting billing information from patient records, whereas medical billing uses those correct codes to create bills and file insurance claims for patients. Creating claims is a process where medical billing and medical coding overlap to form the basis of the revenue cycle of the healthcare industry. The process begins when the patient registers their information and ends when the provider receives full payment for all the services given to the patient. The medical billing and medical coding cycle can take somewhere from a couple of days to many months, based on the complexity of the services offered, denial management of insurance claims, and how facilities manage a patient’s financial responsibility.  

What is Medical Billing and Medical Coding Certification?

A medical coding and billing certification can be a useful way to improve your daily operations and increase your competitive edge in the market. It is a professional credential that recognizes billing and coding specialists and assists them in showcasing their skills to employers. A medical billing and coding specialist handles payments, insurance claims, and medical bills. Both foundational medical billing certification and coding certification and specialty certifications require formal training and certification exam. Most states require medical billers and coders to have at least one active certification. Having multiple coding certifications gives you a clear advantage when applying for jobs.

Medical Billing Certification Requirements

Although the exact requirements of certified medical billing normally differ depending on the certifying company or agency, the following are a few common requirements to become a medical biller and medical code:


To work in the medical field, having prior education, such as a high school diploma, is almost always mandatory. Many coding certifications mandate or prefer that you complete your online medical billing and medical coding education and earn a college degree from a certified university, like an associate degree.

Relevant Experience

A lot of certification programs also require you to have experience working in the areas of medical billing and coding. This experience can verify that you already understand the fundamentals of the medical field and its requirements.


Certification bodies such as the American Medical Billing Association normally require you to pass one or more certification exams before becoming a certified medical biller and coder. The time it takes to complete the questions depends on the organization.    

Types of Medical Billing and Coding Certifications

Medical billers and medical coders can receive their certification from different organizations, the most popular being the American Association of Professional Coders (AAPC) and the American Medical Billing Association (AMBA).


certified medical billingThe AMBA is a professional organization committed to the medical billing field. It has been certifying medical billing professionals via its Certified Medical Reimbursement Specialist CMRS exam for over 10 years. The exam is a detailed one that tests candidates on all aspects of the medical billing process, such as:
  • Managed care
  • Medical terminology
  • Insurance providers and carriers
  • Physiology and anatomy
  • IT and computers
  • ICD 10 CM Coding
  • CMS 1500 Claim form
  • HIPAA compliance
  • Abuse and fraud
  • General information
  • Case studies
You can use the most recent publications to study for your CMRS exam online, including coding manuals. After you have become a certified billing expert, you will need to maintain your medical billing certification by completing 15 credits of continuing education per year. Moreover, you will also need to maintain your annual membership at the organization.


The Certified Coding Associate or CCA certification is an entry-level coding certificate that highlights your skills in hospitals and physicians’ offices. It is not mandatory but a recommended certification with 115 questions and two hours to complete the exam. As a test-taking candidate, you are required to bring your CPT, ICD-10-CM, and ICD-10-PCS code books to the exam. The exam is conducted online and covers six main areas of coding, including clinical classification systems and reimbursement methods.


The Certified Professional Coder or CPC exam is a four-hour multiple-choice exam that requires you to have a membership with the American Academy of Professional Coders. Moreover, you must understand pathophysiology, anatomy, and medical terminology. You can practice for the exam by gaining experience in the coding field or by taking continuing education courses. To pass, you must answer 70% of the questions correctly. After receiving the CPA-A credential, you will be required to get two years of hands-on experience on the job or take an online practice course before you can receive the full coding certificate.


The Certified Coding Specialist or CCS exam includes between 115 and 140 questions and takes around four hours to complete. The AHIMA recommends that you must have several years of coding experience, a CCA or equivalent coding certificate, and a minimum of one year’s coding experience before you can take this exam. This certification is ideal for medical coders and medical billers who are already in the industry and are looking to broaden and strengthen their position. It may also help you get hospital jobs that require coding data used to get reimbursement from government-financed programs and insurance companies.


The Certified Medical Coder or CMC exam is designed for candidates to demonstrate expertise in outpatient settings and medical coding. It requires coding professionals to have a minimum of one year’s experience. You will be required to complete a written exam within six hours or less with the help of current coding books. If you don’t have prior experience as an outpatient medical coder, it is recommended that you take coding classes such as Principles of Coding. You must also have an updated version of HCPCS, ICD-10-CM, and CPT throughout the course and during the exam day.


The American Association of Professional Coders provides the Certified Professional Biller or CPB certification to verify that an experienced medical biller has the appropriate skills to handle all areas of the revenue cycle. It confirms that you thoroughly understand the different kinds of insurance plans and have relevant experience applying local coverage determinations, payer policies, and national coverage determinations. The AAPC suggests earning an associate degree first, permitting only existing association members to apply. The exam takes four hours to complete and includes 135 questions. You need a 70% or more score to qualify for the medical billing certification. Once you become a certified professional biller, you must renew your certification every two years.

General Questions For You

Frequently Asked Questions

Medical billing and coding are essential in the health industry, and professionals with these skills are highly sought after. The most recognized certifications for medical billing and coding professionals are the Certified Professional Coder (CPC) certification from the American Academy of Professional Coders (AAPC) and the Certified Coding Specialist (CCS) certification from the American Health Information Management Association (AHIMA). Both of these coding certifications require passing an exam covering a wide range of medical coding, billing, and health information technology topics.

In addition to these certifications, other certificate programs and continuing education courses are available online or from colleges and universities that can help individuals enhance their coding and billing skills and stay up-to-date with the latest technologies and regulations. These programs may offer college credit, transfer credit, or specialized training in automotive technology, computer science, or business loans.

Medical billing and coding careers require a combination of healthcare-related skills, information systems and technology, and business. Professionals with these skills can expect to secure high-paying positions and enjoy career growth opportunities. Therefore, choosing the proper certification exam, program, or academic degree that meets your needs and goals as a medical billing specialist or coding specialist is essential.

The Crucial Function of Online Medical Scribes in Medical Coding

Obtaining a medical billing and coding certification can significantly enhance your career prospects in the health industry. With the growing demand for skilled professionals who can manage health information and billing processes, having a coding certification can give you a competitive edge in the job market and open up new career opportunities.

A coding certification indicates that you have achieved a certain level of expertise in coding and billing processes. This can help you stand out among other candidates who may not have this specialized skill set. It also demonstrates to potential employers that you are committed to your career and have invested time and effort into gaining the necessary knowledge and skills to succeed in this field.

Moreover, having a coding certification can lead to higher salaries and greater job security. Many employers prefer certified medical billing and coding specialists and are often willing to pay higher rates. A certification can also help you advance in your current position or qualify for more advanced roles in the health industry.

In addition to enhancing career prospects, obtaining a certification can provide valuable continuing education and training opportunities. This can be critical to staying up-to-date with the latest coding and billing practices, healthcare regulations, and technological advancements in the industry.

Obtaining a medical billing and coding certification is an investment in your career. It shows your commitment to your profession and enhances your skills, opening new doors to exciting career paths in healthcare, business, and related fields.

Medical Coding Companies

A medical billing and coding exam covers various topics related to healthcare, billing, and information technology. These exams assess the knowledge and skills required for medical billing and coding professionals.

Some key topics covered in a medical billing and coding exam include medical terminology, anatomy and physiology, healthcare regulations and compliance, medical coding systems such as ICD-10, CPT, and HCPCS, insurance and reimbursement processes, and electronic health records (EHRs).

Medical billing and coding exams may also cover business-related topics like financial management, customer service, and communication skills. Additionally, some exams may include questions on general computer skills and basic IT concepts such as databases, networks, and cybersecurity.

Many students opt to enrol in programs offered by online colleges or training centres to prepare for a medical billing and coding exam. These programs often provide comprehensive training on these critical topics and hands-on practice using industry-standard software and tools.

Continuing education and training are also essential for medical billing and coding professionals as the field evolves. To stay up-to-date with industry trends and regulations, many professionals pursue additional degrees or certifications, attend conferences and workshops, or participate in online training programs.

A medical billing and coding exam covers a broad range of essential topics for success in this field. By mastering these key areas, billing and coding technicians can become valuable assets to healthcare organizations and advance their careers in this growing industry.

Why Should You Hire Medical Billing Outsourcing Companies?

Yes, several reputable online colleges offer medical billing and coding courses that can lead to a coding certificate. These online colleges include Penn Foster College, Career Step, and Ashworth College. These colleges provide comprehensive training in medical billing and coding and hands-on practice using industry-standard software and tools. They also offer certification preparation courses to help students pass the certification exams required for a coding certificate.

Medical Billing and Coding Companies

Handsome bald doctor man with beard wearing glasses and stethoscope over blue background pointing displeased and frustrated to the camera
Parents with little daughter visiting children's doctor in hospital
medical claim billing service

Bottom Line

Medical billers and medical coders find medical billing and coding certification to be a highly valuable tool in the healthcare industry. Certain certifications may allow you to advance your career more quickly, explore new networking opportunities, and choose from various flexible options that best fit your needs and budget.

At Portiva, all our medical billers and coding professionals are certified and trained to meet your needs efficiently. We are amongst a few reputable companies that work tirelessly to offer 24/7 support to our clients cost-effectively. To learn more about our products, get in touch with us today.

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