Medical Billing Forum
General Category => General Questions => : cflorez April 17, 2014, 04:12:30 PM
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As a medical biller I wanted to continue to learn the industry. I was interested in credentialing and coding certification. Does anyone know the best way to go about this. Online or seminars? Cost?
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I don't know about coding certification so I will let someone else answer that.
As for credentialing, I'm not aware of anyone that teaches that. It would be interesting to know if there is. Anyone??
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Credentialing is one of those time honored things you can't really "teach". As you gain experience with the various types of insurance plans you will be able to do credentialing. I think the reason you can't teach it is because the carriers all have their own requirements and you need to know about the various types of insurance plans offered. Credentialing also has 2 tiers to it. Full credentialing is a LOT more involved; contract/fee schedule reviews, negotiations, etc. Straight credentialing is pretty straight forward, the carriers tell you what they want to be credentialed, it's sent in and they send you contract/fee schedule. It can be done manually or using the CAQH's credentialing process. Obviously the more involved you are with credentialing the more money you can make. To do the second level of credentialing though you should have a few years experience and you want to have a really good understanding of managed care contracts and fee schedules.
As for coding, I'd pretty much go no where else than the AAPC as that is the standard and nationally recognized certification.
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I am just getting started with credentialing here (we have 30 providers with new hires every other week and have added 3 locations this year and will be adding another soon, there is a lot to do). I agree that it's not really something that can be easily taught. It's mostly about following instructions, checking off boxes, paying attention to details, responding to the credentialing reps, etc. Pretty basic data entry for the most part. It's just important to be able to do everything correctly and stay very organized. I have nothing to do with contract negotiations, I'm just adding new locations/enrolling providers to our existing contracts which were negotiated by our office manager (who originally used a legal team specializing in this but after so many contracts I think she understood them well enough that she mostly does them herself now). It's slow going the first time around for each insurer because they all want different things for different providers, but once you get through it once it becomes easier. I guess the upside is it costs you nothing to learn through experience (except time and possibly your sanity).
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Hello!
Linda and Richard offered great details and information about credentialing and I agree with what they explained. Credentialing is definitely a learned skill and on the hospital side can be even more involved when you are verifying health care providers schooling and recommendations. This article explains the process in a bit more detail:
http://www.mcres.com/mcrmm08.htm
AAPC offers widely recognized coding credentials as well as AHIMA. In my opinion, it depends on what your long-term goals are as AAPC is professional/facility based coding while AHIMA offers credentials in professional/facility coding as well as in-patient/acute care coding.
While you are researching schools and organizations which offer certificates or credentials, be wary of cost and accreditation. Many technical schools cost a pretty penny and the classes typically don't transfer to traditional university or college if you ever decide to advance in your career.
Hope this helps! :)