The Certified Professional Biller (CPB) credential demonstrates skills related to maintaining all aspects of the revenue cycle, particularly patient and payer billing and collections. Without expertise in medical billing and the nuances of payer requirements, healthcare provider reimbursement may be compromised.

Through rigorous examination and experience, CPBs have proven knowledge of how to submit claims compliant with government regulations and private payer policies. They follow up on claim statuses, resolve claim denials, submit appeals, post payments and adjustments, and manage collections. The CPB medical billing credential is vital to the financial success of the professional healthcare services claims process.

The skills learned through medical coding certification are essential to hospitals, physicians offices, surgery centers, nursing homes, dental offices, home healthcare agencies, mental health facilities and even insurance companies and consulting firms. This rewarding field requires a high level of professionalism and dependability. Tasks performed could include:

• Gathering/reviewing essential information

• Verifying required documentation before patient information is released

• Preventing fraud/abuse by auditing billing

• Supporting coding and billing process

• Assigning codes for diagnoses and procedures

• Submitting claims for reimbursement

• Auditing billing

• Coaching healthcare providers to achieve optimal reimbursement

The Home Care Coding Specialist—Diagnosis (HCS-D) credential is earned by professionals skilled in classifying medical data from home health patient records. Coding specialists review patients' records and assign numeric codes for each diagnosis. Successful HCS-D candidates will possess expertise in the application of ICD-10-CM conventions and guidelines and should be knowledgeable in medical terminology, anatomy/physiology, disease processes, pathophysiology, and pharmacology.

HCS-D certified coders are considered leaders in the industry because they:

• Conduct documentation reconcilliation

• Assign accurate diagnosis codes

• Collaborate with clinicians, physicians and/or managers/administrators

• Ensure that all activities are done in a legal and ethical manner that supports home health agency policy, regulatory and professional guidelines

The Home Care Clinical Specialist – OASIS (HCS-O) certification is held by clinicians who have demonstrated the clinical skills and judgment necessary to assess a patient’s condition correctly. HCS-O credential holders are healthcare professionals with specialized knowledge in applying clinical assessment findings to OASIS items. HCS-O credential holders include Registered Nurses, Physical Therapists, Occupational Therapists, Speech Language Pathologists, Coding Specialists, Billing Specialists, Compliance Directors, Quality Assurance Directors, Administrators, and Agency Directors. Although these individuals perform different jobs, the role of ensuring the accuracy of OASIS data is the same for all of them. To effectively ensure the accuracy of OASIS data, they must understand and apply the instructions contained in the OASIS Guidance Manual, category- specific questions and answers, and quarterly updates provided by the Centers for Medicare and Medicaid Services (CMS).

Clinicians with an HCS-O credential know how to:

• Gather patient clinical documentation

• Validate the accuracy of OASIS responses

• Correct OASIS response errors according to OASIS guidance and documentation standards

• Ensure that all activities are done in a legal and ethical manner that supports agency policy and regulatory and professional guidelines

The Certificate for OASIS Specialist-Clinical (COS-C) credential is for healthcare professionals specializing in home health. The COS-C exam is developed and administered by the OASIS Certificate & Competency Board (OCCB). Since 2004, it has been the premier, nationally standardized, psychometrically validated test to evaluate an individual's knowledge of home healthcare relating to CMS' OASIS guidelines. COS-C specialists who pass this certification exam demonstrate expertise and skills in OASIS regulations, data-collection time points, patient populations, data-collection conventions, and OASIS data set item-by-item guidance.