CPC-P: Certified Professional Coder-Payer Certification

An explanation of the CPC-P certification offered by the AAPC, including everything you need to know about what it qualifies you for and how to get it...

Among the many certifications offered by the American Academy of Professional Coders (AAPC) is the CPC-P, otherwise known as Certified Professional Coder-Payer.

Unlike the other certifications offered by the AAPC, the CPC-P qualifies you as a specialist in an insurance company.

Almost all other AAPC certifications assume that you are working in some sort of physician setting, whether it is in the hospital, doctor's office, or other medical setting. These certifications illustrate your ability to correctly code claims and make sure they have been paid correctly.

The CPC-P, however, assumes that you are working in the payer's office. In other words, that you are working in an insurance company. This certification illustrates your ability to process and pay claims correctly.


What is a CPC-P qualified to do?

Just as in medical offices, more employers in payer's offices are recognizing the importance of hiring qualified individuals. The CPC-P illustrates an individual's ability to analyze medical claims and process them correctly for payment.

This is especially important in the payer's office because payer guidelines and recommendations for medical care are constantly changing.

A specialist in the payer's office needs to be able to efficiently analyze claims, compare them to current coding and payer guidelines, and evaluate them for medical necessity, before they can be sent for payment.

This means that a CPC-P is qualified to receive and examine medical claims, and figure out whether or not the claim meets medical necessity guidelines, whether or not the patient is covered to receive such benefits, and whether or not to pay the claim, either in full or in part.


What does a CPC-P have to know?

Whereas other coding certifications offered by the AAPC focus on the coding aspects of working in the doctor's office, the CPC-P focuses on the coding aspects of working at an insurance company.

This includes knowing appropriate coding guidelines and typical insurance industry standards, and how they work together to pay on medical claims. The CPC-P, also needs to know how these industry standards work for different services, such as inpatient, outpatient, and supply services.

The CPC-P also focuses on reimbursement methodologies for both inpatient and outpatient services, as well as important health insurance concepts, including HIPAA, CPT, ICD-9, and HCPCS coding.

In short, the CPC-P has to know most of the ins-and-outs of the way an insurance company works, and how they determine how, why, and when to pay claims. They also have be current on all changes in insurance processing guidelines and standards of care.


Who should get the CPC-P?

Unlike the other certifications offered by the AAPC, the CPC-P can only be used in a payer's office.

Claims reviewers, utilization managers, auditors, and benefits administrators are all suited to benefit from the CPC-P. Other professionals who work in billing services, provider relations, contracting, and customer service can also benefit from the credential.

Either way, it is important to remember that individuals who get their CPC-P are qualified to work on the other side of the healthcare spectrum.

Whereas most coding certifications qualify you as a person to work in the doctor's office and code and send claims correctly, the CPC-P qualifies you to work in the insurance company, and process and pay claims correctly.

This means that if you get your CPC-P, you need to have experience and knowledge in working in a payer's office.


How do you get the CPC-P certification?

You can get the CPC-P certification just as you would any other AAPC certification. This means that you first have to be a member of the AAPC. Once you are a member you can register for the test. This is as simple as paying an annual membership fee and remaining within their standards of ethical practice.

You also have to be prepared to take the test. Few medical billing and coding programs include any kind of training in working in a payer's office, so unless you can find a program suited to this end, you have to get enough on-the-job training in order to pass the test.

The AAPC does also offer additional study materials, including a CPC-P exam study guide and a CPC-P practice exam, which can help you pass the test. If you are in an area with a local chapter of the AAPC, you may also want to see if they have additional training materials to help you pass the test.

For more information on the CPC-P exam, go to http://www.aapc.com/certification/cpc-p.aspx


After you pass the test...

Just like all other certifications offered by the AAPC, this one also comes with the requirement of continuing education units (CEUs). These CEUs consist of the most current information, which may be especially important in the payer setting, as payer guidelines change often.

The CPC-P credential is a great way to illustrate your expertise in a growing area in the medical industry. It allows you to work in the entire field of medical insurance, from claims review to HIPAA regulations - your options are virtually unlimited.

The CPC-P credential illustrates knowledge of a highly specialized area, which is in great need of qualified, intelligent individuals, who can correctly analyze and process medical claims. If you feel that this is the right area for you, prepare for the exam and pass that test. Good luck!




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