The Certified Medical Coder is a leading certification for medical coding professionals that work with outpatient claims. The training program prepares candidates with advanced knowledge of the reimbursement cycle from patient encounter to claim. These skills are imperative for proper claim submission and accurate payment for services rendered.
For employers, auditors, and business associates, CMC signifies an ongoing commitment to continued professional development. Those who continue to expand their professional knowledge will have the edge in today's ever-changing healthcare climate.
Benefits of becoming/hiring a Certified Medical Coder:
· protects the practice’s financial health by decreasing claim denials, and improving billing accuracy and compliance with current guidelines
· does not rely on EHR presets, web searches or coding cheat sheets for coding assignments, which can cause repeat problems and trigger an audit
· communicates with confidence with physicians, third-party payers, patients and business associates, which promotes advancement into chart auditing and supervisory roles
For more than 35 years, PMI’s training has been recognized in health care systems, hospitals, medical societies, physician organizations, and learning institutions across the country. There are other coding certifications offered through organizations such as AHIMA and the AAPC. Some certifying bodies advertise their coding certification as the only recognized option, but the truth is that no government body recognizes or endorses a particular medical coding certification program over another. The training for each of these programs is very similar in terms of industry-standard guidelines and competency requirements for outpatient coders.
In 2004, the Centers for Medicare and Medicaid Services (CMS) named Practice Management Institute along with the American Health Information Management Association (AHIMA), and the American Academy of Professional Coders (AAPC) as organizations that provide advanced coding training for CMS-employed Provider Relations Research Specialists. This was in reference to the Medicare Modernization Act Provider Customer Service Program advanced training requirements needed to address complex provider questions pertaining to coverage, coding, and payment policies.1
The U.S. Department of Labor (DOL) lists the CMC in its online career training resource.2 Recognition by CMS, DOL, medical societies, learning institutions, and healthcare organizations across the country underlines the recognition of this certification as a leading provider of certification for medical office coding staff.
1. The Centers for Medicare and Medicaid Services transmittal: https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R113OTN.pdf CMS Manual System, Pub. 100-20, Transmittal 113, September 10, 2014. SUBJECT: Implementation of § 921 of the Medicare Modernization Act (MMA) – Provider Customer Service Program, page 8, bottom paragraph
2. U.S. Department of Labor, Employment and Training Administration recognition of the CMC: http://www.careerinfonet.org/certifications_new/default.aspx, type Certified Medical Coder in the "Find a Certification" box
Use certified medical coders to help navigate reimbursement regulation changes, PMI says, Kelly Gooch, Beckers Hospital CFO Report 2017 Aug 23
Easy tips for physicians to reduce billing errors, Keith Loria, Medical Economics, 2017 Aug 2
The Value of a Coding Education, John Rowe, MD, Blake Fagan, MD, David Mouw, MD, Dottie King and Kelly Christianson, Fam Pract Manag. 2005 Mar;12(3):20-22 http://www.aafp.org/fpm/20050300/20thev.html
The Certified Medical Coder (CMC) is designed for experienced coders that have a minimum of one year of work experience as an outpatient medical coder. All candidates are encouraged to complete PMI’s free online Medical Coding Assessment to test their base knowledge and identify areas of deficiency where training may be beneficial in advance of the course. Candidates with less experience or wishing to brush up on their skills may consider completing the Principles of Coding before beginning the more intensive certification course.
Fundamental Training Recommendation
Inexperienced coders and those new to the field will benefit from fundamental training prior to attempting the Principles of Coding course referenced in the paragraph above. The Medical Coding Basics Bundle is a four-part series that covers the fundamentals of coding guidelines as well as an introduction to CPT, ICD-10-CM, and E/M coding.
Required Self-Supplied Materials
Students must have access to current editions of CPT®, HCPCS, ICD-10-CM, and a medical dictionary throughout the course and on the exam day. These coding reference materials are updated annually. The ICD-10-CM code set manual is valid through September 30 of the calendar year noted on the cover. The codes for the subsequent year go into effect on October 1 each year. CPT and HCPCS code sets are effective for the calendar year period beginning January 1 and ending December 31. PMI certification course students should utilize coding resources that are current at the time of their participation in the course and exam. Candidates that schedule an exam appointment for the next calendar year should bring coding books that are current on the date of their exam.
Practice Management Institute (PMI) used current AMA published versions of the three coding manuals in the preparation of this course and exam. While the usage of these materials does not in any way indicate the endorsement of a particular brand by Practice Management Institute, these resources are recommended to minimize potential discrepancies in coding information provided. Students should also be aware that the AMA publishes the only CPT® codebook with the official CPT guidelines. PMI does not sell medical coding books, but they are widely available for purchase or lease through a variety of nationwide publishers and retailers.
Earning CMC certification requires a passing score of 70 percent or better on the written exam. All exams are proctored live in testing centers across the country. Candidates have up to six hours to review questions and coding books and write in their answers based on the criteria given. Codes selected must designate the highest degree of specificity based on the documentation provided using current coding reference books. Exams are hand-graded and verified twice. In an age of digitized grading systems designed to simplify the grading process, PMI stands by its resolute exam standards as the most accurate measure of a CMC candidate’s coding ability.
Certified Professional Standards of Excellence
Practice Management Institute certified professionals are required to uphold high professional standards, established by the Practice Management Institute Advisory Board for Certification Programming. Ethics requirements include adherence to legal guidelines according to governmental and third-party payer organizations and contracts.
Maintaining the CMC Certification
Medical office professionals, particularly those working in reimbursement roles, must stay current on updates and changes each year. Keeping the CMC certification active requires an ongoing commitment to continuing education. Twelve hours of continuing education are required each year to maintain active certification status. For information about renewing the CMC certification, visit the “Certification Renewal” section of our website.
Attend instructor-led classroom sessions, hosted in select hospitals, healthcare organizations, medical societies and colleges across the U.S.
Live Certified Medical Coder classroom format includes a full course manual with workbook exercises, medical terminology course access, a practice exam, and timed, six-hour proctored certification exam. A score of 70% or better is required to earn the CMC certification. If a passing grade is not achieved on the first attempt, candidates may re-test for an additional fee.
Participate in the Certified Medical Coder course remotely with access to a series of twelve live 90-minute instructor-led webinar sessions (limited availability). Live session attendance is not required; registered webinar participants can access the recordings online anytime 24-48 hours after the original recording date.
This format also includes a full course manual with workbook exercises, medical terminology course access, a practice exam, and timed, six-hour proctored certification exam scheduled by PMI’s Exam Coordinator in a testing center near the candidate’s location. A score of 70% or better is required to earn the CMC certification. If a passing grade is not achieved on the first attempt, candidates may re-test for an additional fee.
Start the Certified Medical Coder online training program anytime with access to twelve pre-recorded 90-minute instructor-led sessions.
The Certified Medical Coder on-demand format includes a full course manual with workbook exercises, medical terminology course access, a practice exam, and timed, six-hour proctored certification exam scheduled by PMI’s Exam Coordinator in a testing center near the candidate’s location. A score of 70% or better is required to earn the CMC certification. If a passing grade is not achieved on the first attempt, candidates may re-test for an additional fee.
All candidates for the CMC certification must pass a written exam, proctored live in testing centers across the country. Six hours are allowed to complete the exam; a passing score is 70 percent or better is required to earn the certification.
Candidates will review questions and write in their answers based on the criteria given. Codes selected must designate the highest degree of specificity. Written answers eliminate deselection of incorrect answers to arrive at the correct answer, which may allow a candidate to guess his/her way to a passing grade.
Exams are hand-graded and verified through a second grading process. In an age of digitized grading to simplify the grading process, PMI stands by this manual testing method as the most accurate measure of a candidate’s coding ability.