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The Not-So-New Kid on the Block
Practice Management Institute's Certified Medical Coder Credential
 What is certification? A good working definition is: a process to verify the authenticity of a person or thing. A medical education culminates with an MD. Accountants become CPAs. Becoming a certified medical coder is the ultimate goal in the coding profession. It is a means of authenticating a person's level of coding knowledge by successful completion of a third party exam.
How do you evaluate the quality of a particular credential? There are several ways to evaluate a certification, according to Douglas O'Dell, President and CEO of Practice Management Institute (PMI). Key elements are: the organization behind the credential, the quality and integrity of the exam, and the recognition of the credential in the marketplace.
Who Is PMI
Over the past 25 years, PMI has presented well over 30,000 practice management workshops for doctors and their staff. In 1991, PMI introduced its first credential. Today, it maintains three certifications for medical office professionals, earned by more than 12,000 individuals in the U.S. and abroad.
 Measuring Quality and Integrity
Unlike other coding certifications, the CMC exam is not multiple-choice. PMI determined long ago that multiple-choice exams are not the best tool for determining coding competency. Providing the correct answer, even among incorrect choices, gives the candidate a distinct advantage over testing methods that require the candidate to independently determine the answer. A CMC candidate must truly understand the coding process. They show up with their books and a pencil. If they can't code from scratch, they don't pass the exam. Proficiency in CPT, ICD-9-CM, and HCPCS coding, documentation guidelines, compliance and reporting systems is measured and candidates must code to the highest degree of specificity. The exam consists of medical terminology, coding exercises and scenarios to code. Candidates must pass with a grade of 70 percent or higher.
Additionally, PMI has strict protocols in place for proctoring the exam. Whereas some organizations have moved into an online format for testing, PMI's position is that certified coders are far too important to risk any chance of impropriety. There is no way in an online environment to ensure that the candidate is not receiving some form of outside assistance. All candidates are tested in a live setting, under supervision by PMI approved personnel.
"At the end of the day we feel that our testing standards are the most stringent in the industry," said O'Dell.
Recognition
In recent years, the CMC credential has garnered increased recognition by employers such as the Cleveland Clinic Foundation, and payers like the Centers for Medicare and Medicaid Services (CMS). CMS cited PMI as an example of an acceptable certification for its Intermediary Provider Customer Service Program, part of the 2003 Medicare Modernization Act.
"We have found that PMI's CMC credential carries considerable weight in the medical community during the hiring process; both in terms of respect for the applicant's coding skills and as a basis for salary offers," says Rose Moore, Physician Practice Advocate for the Medical Society of Virginia.
MedNet One in Michigan recently contracted to have 100 of their coders trained by PMI to earn their CMC credential. Last month the San Diego County Medical Society hosted a full house CMC prep course at their facility for the San Diego community.
Heather Post, a provider relations manager for Ark-La-Tex Health Network in Texarkana, Texas, is encouraged by the surge of interest among physicians in her area.
"Physicians see the value in their practices after their coders attend the certification course," says Post. "To watch the positive peer pressure created in our medical community from the CMC certification is refreshing."
Success Stories
Certification in coding and billing has been the best line of defense for Patricia Demirjian, practice administrator at Demirjian Neurology and Pain Management in Dayton, Ohio. She holds five professional certifications, three of which are through PMI. In the past eight years, her practice has undergone three Medicare audits. Each time, they scored 100 percent, which is considered by Medicare to be very rare.
"The last time, they came in and made copies over a three-day period. Then, when they left, they had me copy and send the rest of the tagged files to them."
It took a year for Demirjian to receive a follow-up notice. When she finally received the results, she discovered that the audit rejected five procedures because there were no fluoroscopies attached, and a bill for $2500 was included in the envelope.
"Fortunately, I had kept records of all the copies I had made for them, so I pulled out the file and faxed the fluoroscopies that had been sent to them originally. When all was said and done, it turned out that we owed them nothing!"
Demirjian knows first-hand the value of her certifications to her career. Her skills allow the physician to stay focused on the patients, while she and her staff take care of the dollars. Her collection rates are on target and she credits this to strong emphasis on staff training and cross-training, the majority of which she has received through PMI over the years.
PMI's training and certifications have traditionally been a means to improve and validate experienced medical office professionals' existing body of knowledge. In recent years, its certifications and training materials are being grafted into college settings, creating new beginnings for budding professionals.
Deborah Gillespie had worked all of her professional life at a Hitachi manufacturing plant in South Carolina. When her job was suddenly eliminated, she was forced to reevaluate her career path and looked to the local employment office for advice.
"I was absolutely scared out of my mind," says Gillespie. "Manufacturing was all I had ever known, but I decided that it was time I tried something else."
Gillespie was counseled by the employment office and found her way to the Health Sciences Department at Greenville Technical College. From there, she went on to earn two certifications in medical coding and billing. About ten years ago, the college began partnering with PMI through their Allied Health Services Department to augment their career-changing curriculum. To date, literally hundreds of their students have gone on to earn the CMC credential.
"They helped me find the self-esteem I had lost somewhere along the way. I will always be grateful," says Gillespie, who now works for an insurance carrier in Greenville, SC.
Velina Palmer, a data analyst at Methodist Mansfield Medical Center who recently earned the CMC certification, shared her accomplishment. In September, Palmer accepted a trauma registrar position at Cooks Children's Hospital, the busiest pediatric trauma unit in Fort Worth.
"The first thing I did was add the credential to my name and add the CMC pin to my badge. This is a proud achievement for me," said Palmer.
Michelle Johnson, a practice manager in Central Wyoming, says there are few well-trained billers and coders in the small Midwestern community where she works.
"These practices are losing lots of revenue because of untrained staff," says Johnson. This year, Johnson taught two Certified Medical Coder (CMC) certification classes at Casper College. She says her students appreciate the opportunity to get trained locally and earn their certification.
Preparing for the Exam
CMC preparatory programs are presented in leading healthcare systems, hospitals, medical societies and colleges such as Louisiana State University and the University of Texas at Arlington. PMI has found that people are more receptive to learning in a live classroom environment rather than web-based or audio classes. For this reason, their instructors prefer to travel to local communities and stand in front of class participants.
"Our trainers are seasoned professionals with a love for teaching and enthusiasm about the subject matter," said O'Dell.
PMI's Professional Services Department consistently researches and updates educational materials based on legislative and Medicare alerts. Workbooks are printed on demand and reviewed at least quarterly with crucial changes being incorporated into manuals rapidly.
But for those who cannot attend the live classes, PMI offers a Self Study version of its live class presentation. It includes all classroom lectures on CD, and course materials. Assistance is available throughout the process through a faculty-monitored discussion forum and a toll-free assistance hotline.
The CMC credential validates a person's commitment to the industry, offers a sense of personal achievement, and provides a currency to demonstrate one's superior knowledge to employers and payers alike.
"If we're doing our job properly, then physicians will have a well-qualified pool of professionals to keep them compliant and help maintain proper reimbursement," said O'Dell.
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