The Difference Between Certified Coders and Non-Certified Coders

Billing & Reimbursement ICD-10 Medical Coding

Certified Coders There is a significant difference between certified and non-certified medical coders. While there are no legal requirements for certification to be a medical coder, certified medical coders possess credentials that identify them as experts in their field. In addition to passing rigorous exams for medical coding, a certified coder has passed exams in gross anatomy and medical terminology, giving them critical knowledge and proficiency important for reading and interpreting patient charts correctly.

 Industry Standard

Certification is the industry standard for medical coders; with the Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) the basic (and most sought after) credentials. For a busy physician’s practice, the difference between certified and non-certified coders performing healthcare billing services could potentially be measured in millions of dollars. A collaborative partnership with Healthcare Information Services, LLC. (HIS) can strengthen your healthcare billing services and increase your practice’s revenue.

Extensive Knowledge

Certified medical coders possess extensive knowledge of ICD-9, HCPCS and CPT coding books, and will work to stay current with the frequent changes to coding, procedures, and new reimbursement policies. Additionally, with the transition to ICD-10 coming in October, 2013; they will have identified a professional responsibility to be ready for the new codes. Certified medical coders reduce errors in your office’s healthcare billing services; resulting in faster payment, fewer denied claims, and increased revenue. HIS’ medical coders are certified and boast a 98% clean claims rate, compared with the clean claims rate of 70-80% which is typical of offices that utilize an in-house billing services team. Clean claims result in fast payment, which translates into increased revenue.

 Timely Filing

Certified coders also recognize the need to file claims timely. Private payers often impose a time limit of 60 days or less, and Medicare only allows a 120 day window to dispute a claim denial. Resubmission of denied claims and appeals are labor intensive, complicated processes that many practices neglect to pursue with in-house healthcare billing services teams, and non certified coders often lack the expertise and experience to handle these matters, resulting in missed revenue. Finally, HIS certified medical coders perform auditing duties that keep your practice compliant by ensuring that all billable activity is correctly captured. 


Certified medical coders are recognized as healthcare industry professionals who have made a commitment to gain the necessary expertise to provide the highest quality healthcare possible; HIS certified coders distinguish themselves as working for the industry leader in healthcare informatics.

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