The ABCs of Certification “Which is Right for You?” - DoctorsManagement The ABCs of Certification “Which is Right for You?” - DoctorsManagement

The ABCs of Certification

“Which is Right for You?”

by Sean Weiss,Partner & VP of Compliance

We work in an industry monitored and regulated by agencies based on the alphabet so… it only makes sense that we would have an alphabet after our name. The question is which one(s) are right for you and are they really worth having? Depending on your position and/ or your career goals will dictate your educational path. The one thing I know for certain is that Billers, Coders, Auditors, and Compliance Professionals take certifications very seriously and most who have never achieved a formal college education look at their certifications as their diplomas. I have been at this formally since 1995 and can honestly say that some of the certifications I studied for were as difficult if not more so than the majority of college courses I took including Statistics and Quantitative Methods of Business (QMB).

So, with all of the options out there between “Core” coding certifications, specialty specific certifications, payer specific certifications, auditing certifications, specialty auditing certifications, compliance certifications, and on and on and on; which one(s) are the most recognized and which one(s) are right for you?

Here is a breakdown of each certifying group and the credentials they offer:

  1. American Academy of Professional Coders (AAPC) – This organization was founded in 1988 has more than 180,000 members and offers a slew of certifications, but the following are those considered to be their most popular:
  1. American Health Information Management Association (AHIMA) – AHIMA was founded in 1928, AHIMA is the premier association of health information management (HIM) professionals worldwide. Serving 52 affiliated component state associations and more than 103,000 health information professionals, AHIMA is the leading authority for “HIM knowledge” and widely respected for its esteemed credentials and rigorous professional education and training. Below are the Certifications offered by this organization:
  1. National Alliance of Medical Auditing Specialists (NAMAS) – NAMAS was founded in 2007 as a subsidiary of DoctorsManagement. In 2010, NAMAS and the AAPC joined forces and the AAPC took ownership of the CPMA® credential and exam, while NAMAS continues to train auditors as the only AAPC-approved trainer for the CPMA® exam. NAMAS offers the following Certifications:
  1. Practice Management Institute (PMI) – PMI was founded in 1983 and offers the following certifications :
  • CMC
  • CMIS
  • CMOM
  • CMCO
  • CMCA
  1. Health Care Compliance Association (HCCA) – HCCA was founded in 1996 and is a is a 501(c)(6) member-based association for healthcare compliance professionals. Serving more than 12,000 members across the country, we’re dedicated to enabling the lasting success and integrity of those working in, working with or supporting healthcare organizations. Members include compliance officers and staff working in hospitals, research facilities, clinics, and technology services providers, as well as anyone providing services or goods to these organizations or the compliance community. Their certifications include:

Although I have only listed the five (5) above there are others out there that are not as widely known but may offer a strong curriculum to test your knowledge and demonstrate your understanding for the materials.

The truth is you can spend tens of thousands of dollars earning various certifications between prep course, testing fees, membership dues, conference fees, CEU fees, etc. so make sure you understand thoroughly each of the certifications you have interest in and determine whether or not it will benefit you and your career. You should also look at salary surveys to gain perspective. According to AAPC in 2017 the average salary climbed nearly 6 percent, to $52,648 and the overall respondent unemployment rate

dropped from 6.6 percent to 5.9 percent. Take a look at the graphs and charts below:


Source: for the above Charts and Graphs comes from:
Then there is the survey conducted by NAMAS for the same year:


Source: For the above charts and graphs: 2017 Salary Survey Results Published March 2018 by National Alliance of Medical Auditing Specialists

For me, I hold seven (7) certifications but have achieved many more over the years. The ones listed below are those that I have found to be universally accepted and required by employers. My credentials include: CHC (HCCA), CEMA (NAMAS), CMCO (PMI), CPMA (AAPC), CMPE (AAPC), CPC-P (AAPC), and CPC (AAPC). I chose my certifications based on roles at the companies I worked at and what my job functions were at the time. However, as my interests in regulatory compliance and health law continued to expand throughout the early 00s – 2019 I sought more compliance and payer centered certifications (CHC, CPC-P and CMCO) since the bulk of the work I perform is in Strategic Litigation Defense, Audit Appeal, Fraud Investigations, Testifying in State and Federal Court Cases, Serving as an expert in arbitration/mediation hearings, and building compliance plans for clients across the country. However, my “Core” credentials (CPC, CPMA, and CPC-P) remain critical in being able to demonstrate competency in my both fundamental and advanced knowledge of coding and auditing.

The one area tied to certifications that concern me and I am sure many of you reading this post is the fact that a successful candidate achieving certification did so by demonstrating the ability to read, retain, and regurgitate. We have all worked with that individual who was “Certified” who could not code their way out of a book or demonstrate understanding of compliance concepts critical to their job. Holding a certification or 10 does not mean they can perform the work required at the highest level, and that is unfortunately the false sense of security employers get with hiring folks with a certification. So, to employers that are reading this post there are steps that can be taken to ensure your employee is in the right position and possessing the requisite knowledge to perform their job at the highest level. Annual performance reviews should include aspects such as Audit the Coder or Audit the Auditor to ensure employee knowledge and mastery of subject matter, providing internal education specific to their job function(s), and having internal testing based on the actual work being performed. I know it sounds like a lot of work but it beats the alternative of an OIG or CMS audit whereby they determine a high error rate resulting in the return on significant monies and potentially worse; civil or criminal actions against your organization and leadership team.

At the end of the day Certifications are a great way to show an employer that you possess the foundational skills and also with some certifications a mastery of your craft. So be loud and proud of your achievements and work hard daily to perfect your craft and hone your skills. In the end even if you don’t make a million dollars, you still achieved something no one can strip you of; an education!

What to do next…

  1. If you need help with an audit appeal or regulatory compliance concern, contact us at (800) 635-4040 or via email at
  2. Read more about our: Total Compliance Solution

Why do thousands of providers trust DoctorsManagement to help improve their compliance programs and the health of their business?

Experienced compliance professionals. Our compliance services are structured by a chief compliance officer and supported by a team that includes physicians, attorneys and a team of experienced auditors. The team has many decades of combined experience helping protect the interests of physicians and the organizations they serve.

Quality of coders and auditors. Our US-based auditors receive ongoing training and support from our education division, NAMAS (National Alliance of Medical Auditing Specialists). All team members possess over 15 years of experience and hold both the Certified Professional Coder (CPC®) as well as the Certified Professional Medical Auditor (CPMA®) credentials.

Proprietary risk-assessment technology – our auditing team uses ComplianceRiskAnalyzer(CRA)®, a sophisticated analytics solution that assesses critical risk areas. It enables our auditors to precisely select encounters that pose the greatest risk of triggering an audit so that they can be reviewed and the risk can be mitigated.

Synergy – DoctorsManagement is a full-service healthcare consultancy firm. The many departments within our firm work together to help clients rise above the complexities faced by today’s healthcare professionals. As a result, you receive quality solutions from a team of individuals who are current on every aspect of the business of medicine.