National Certification Exam Rubric & Resources
Full Name: Certified Billing & Coding Specialist | Website: www.nhanow.com
| Domain | Description |
|---|---|
| 1. Revenue Cycle & Regulatory Compliance | Healthcare billing cycle, HIPAA compliance, fraud/abuse prevention, legal/regulatory requirements, documentation standards |
| 2. Insurance Eligibility & Payer Requirements | Insurance verification, eligibility determination, preauthorization, referrals, coordination of benefits, payer-specific requirements |
| 3. Coding & Coding Guidelines | ICD-10-CM diagnostic coding, CPT procedural coding, HCPCS Level II coding, modifiers, coding guidelines, documentation review for accurate coding |
| 4. Billing & Reimbursement | CMS-1500 form completion, claims submission (electronic and paper), claim status tracking, denials management, appeals process, payment posting, aging reports |
Full Name: Medical Coder & Biller Certification | Website: www.amcaexams.com
Accreditation: NCCA accredited as of September 1, 2018
| Domain | Description |
|---|---|
| 1. Medical Terminology & Anatomy | Medical word parts (prefixes, roots, suffixes), body systems, anatomical terminology |
| 2. ICD-10-CM Coding | Diagnostic coding, code structure, tabular list, alphabetic index, coding guidelines, sequencing |
| 3. CPT Coding | Procedural coding, Evaluation & Management codes, surgery, radiology, pathology/lab, medicine section |
| 4. HCPCS Level II Coding | National codes for supplies, equipment, ambulance services, drugs |
| 5. Billing Procedures | Claims preparation, CMS-1500 form, electronic submission, billing cycle |
| 6. Insurance & Payers | Commercial insurance, Medicare, Medicaid, managed care, verification, authorization |
| 7. Regulatory Compliance | HIPAA, fraud and abuse laws, Office of Inspector General (OIG), compliance programs |
| 8. Professional Practices | Documentation requirements, medical record keeping, ethical responsibilities, revenue cycle management |
Full Name: National Certified Insurance & Coding Specialist | Website: www.ncctinc.com
| Content Area | Description |
|---|---|
| Insurance Billing | Healthcare billing processes, electronic claims submission, claim tracking, denial management, appeals |
| Medical Terminology | Healthcare vocabulary, anatomical terms, disease processes, medical abbreviations |
| CPT Coding | Current Procedural Terminology coding, E/M services, surgical procedures, modifiers |
| ICD-10-CM Coding | Diagnostic coding, code structure, coding conventions, guidelines, official coding rules |
| HCPCS Level II Coding | Healthcare Common Procedure Coding System, durable medical equipment, supplies, drugs |
Full Name: Certified Professional Coder | Website: www.aapc.com
| Content Area | Approx. % | Description |
|---|---|---|
| Medical Terminology | 10% | Prefixes, suffixes, root words, anatomical terms |
| Anatomy & Physiology | 15% | Body systems, organs, pathophysiology |
| ICD-10-CM Diagnostic Coding | 20% | Disease classification, coding conventions, guidelines, sequencing |
| CPT & HCPCS Coding | 35–40% | Procedural coding across all specialties, modifiers, bundling/unbundling |
| Coding Guidelines | 10–15% | Official coding guidelines, compliance, documentation |
| Practice Management | 5–10% | Reimbursement methodologies, compliance, quality measures |
Full Name: Certified Professional Biller | Website: www.aapc.com
| Content Area | Description |
|---|---|
| Revenue Cycle Management | Complete billing cycle from patient registration through final payment, denials management, collections |
| Healthcare Reimbursement | Medicare, Medicaid, commercial insurance, managed care, fee schedules, payment methodologies |
| Claims Processing | CMS-1500 form completion, electronic vs. paper claims, clearinghouses, claim scrubbing, submission |
| Regulatory Compliance | HIPAA, False Claims Act, Fair Debt Collection, Anti-Kickback Statute, Stark Law |
| Coding Fundamentals | Basic ICD-10-CM, CPT, HCPCS coding (lighter emphasis than CPC exam), modifiers |
| Insurance Types & Plans | Commercial, government programs, workers compensation, third-party liability, coordination of benefits |
| Denials & Appeals | Denial reasons, appeals process, documentation requirements, reconsideration procedures |
| Feature | NHA CBCS | AMCA MCBC | NCCT NCICS | AAPC CPC | AAPC CPB |
|---|---|---|---|---|---|
| Questions | 100 scored | 100 | 132 scored | 150 | 200 |
| Time | 3 hours | 2 hours | 2.5 hours | 4 hours | 5h 40m |
| Pass Score | 390 scaled | 64% | 70 scaled | 70% | 65% |
| Focus | Billing & Coding | Coding & Billing | Billing & Coding | Coding Primary | Billing Primary |
| Manuals | Electronic (2024+) | Required | Required | Open book | Open book |
| Renewal | 2 yrs (10 CE) | Varies | 5 yrs (annual CE) | 2 yrs (36 CEUs) | 2 yrs (36 CEUs) |
| Cost Range | Varies | ~$119 | Varies | $460–560 | $260–300 |