How to Pass the Medical Billing Certification Exam - MedCerts

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How to Prep For & Pass the Medical Billing Certification Exam

Medical billing specialists are more important than ever in providing exceptional patient healthcare. Plus, the job market is optimistic—the demand for medical billing specialists is projected to grow by 7% in the next eight years, creating more than 12,000 new entry-level positions across the healthcare industry.

By taking and passing the Medical Coding and Billing Certification exam (MCBC), you can distinguish yourself as a qualified candidate to potential employers and position yourself for better career opportunities in the long run. So if you're ready to learn what it takes to ace the medical billing exam, be sure to read this guide from top to bottom—here’s everything you need to know.

What Is the Medical Billing Exam?

The certified medical biller exam assesses the entry-level knowledge needed to succeed in a career as a medical billing specialist. These healthcare professionals manage the billing process for healthcare facilities, including managing invoices and processing claims for reimbursement. The MCBC exam ensures you have a firm understanding of the knowledge and responsibilities required to excel in this critical role.

Medical Billing Exam Eligibility Requirements

To be eligible to take the medical billing exam and hold an active medical billing certification, you have to meet the following criteria:

1. You must be 18 years old with a high school diploma or equivalent.

2. You must meet at least one of the following requirements:

  • Graduate from an accredited medical billing specialist certificate program like MedCerts and pass the MCBC exam within one year of program completion. You must have proof of course completion to be eligible.

  • Have a minimum of one year of hands-on experience directly related to medical billing and currently work in the field. You must have employer verification to be eligible.

3. You must also agree and adhere to the AMCA Code of Ethics.

Exam Sections and Essential Content

The Medical Coding and Billing Certification exam is issued by the American Medical Certification Association, an accredited organization supporting professionals across the healthcare industry. The MCBC includes 100 multiple-choice questions, and examinees have two hours to complete the exam. A score of 64% or higher is needed to pass. You can take the medical billing exam online or on paper

The MCBC exam includes eight sections, each with its own weight and Job Task List. Here's a snapshot of what you can expect to see:

  1. Medical Terminology and Anatomy: 11 Questions

This section covers terminology and functions related to medical practices and organ systems. You'll come across these terms on a daily basis in your role as a medical coder and biller, so it's crucial to demonstrate mastery of anatomical and medical terms. Topics on this section of the exam may include:

  • Surgery, anesthesia, and radiology

  • Immunizations, vaccines, and dialysis

  • Musculoskeletal, respiratory, and cardiovascular systems and organs

  • Body planes and directional terms

  1. Physicians' Current Procedural Terminology (CPT) / Health Care Common Procedural Coding System (HCPCS): 17 Questions

This is the most extensive exam section and covers fundamental technical knowledge, including the key medical codes and procedure codes you'll need to know to perform your billing duties. Medical billing and coding professionals should know these like the back of their hand, as these coding procedures are integral to the role. Some topics in this section include:

  • CPT code interpretation and terminology

  • Anesthesia and surgery codes

  • Pathology and Laboratory codes

  • Place-of-Service codes

  1. International Classification of Diseases (ICD-10): 16 Questions

Be prepared to get granular on how to identify illnesses and medical diseases using the ICD-10. The ICD format promotes international collaboration and helps track illness and mortality statistics across the globe to help further humanity's collective understanding of medicine. You'll encounter topics such as:

  • Code sequencing, including laterality

  • Diseases of the Nervous System, Circulatory System, and Respiratory System

  • Congenital malformations, deformations, and chromosomal abnormalities

  • Injury and Poisoning

  1. Types of Insurance: 8 Questions

It may be the smallest section of the exam, but you'll need an extensive understanding of health insurance companies and handling health insurance claims to succeed in a medical billing specialist role. Some of the topics for this portion may include:

  • Managed care

  • Medicare, Medicaid, Medigap

  • Blue Cross/Blue Shield

  • Worker's Compensation

  1. Billing Regulations: 11 Questions

Knowing the laws and regulations around medical billing procedures is another important aspect of your profession as a medical biller. On this portion of the exam, you'll need to demonstrate knowledge about topics like:

  • Accountable Care Organizations (ACO)

  • Incident-to-billing

  • Completion of CMS-1500

  • Payer payment policies

  1. Reimbursement and Collections: 12 Questions

Working in the billing department of any industry means managing challenges with reimbursement and collections. Be prepared to show what you know about topics that include:

  • Provider credentialing

  • Patient dismissal

  • Professional courtesy

  • Payment plans

  1. Billing: 16 Questions

As the second largest portion of the exam, this section focuses on the execution of billing practices, including your responsibilities when interacting with patients. Examinees need to demonstrate knowledge about:

  • Explanations of Benefits (EOBs)

  • Retention of medical records

  • Telephone courtesy

  • Claim rejections

  1. Regulations and Guidelines: 10 Questions

Finally, this section covers the extensive rules and regulations that govern the healthcare industry. Here you'll need to show that you understand topics such as:

  • Organization and Corporate compliance plans

  • CMS regulations (e.g., diagnostic supervision rules)

  • Health Insurance Portability and Accountability Act (HIPAA)

  • Purpose of waiver of copayments and deductibles

How to Register For the Medical Billing Exam Online

If you completed a medical billing and coding certification program at an AMCA Approved Test Site, your instructors will guide you through the exam registration process. You will not need to pay the $25 exam application fee for approval or independently register for the exam. MedCerts graduates are automatically eligible for the exam and don't have to pay the additional $109 exam fee.

If you graduated from a non-AMCA Approved Test Site or are registering after at least one year of working in the field, you will first have to be approved to take the exam. Once approved, you have 60 days to pay for and register to take the exam on the AMCA website.

Preparing For the Exam: Medical Billing Specialist Online Certification Training

Finishing an accredited, AMCA-authorized online certification course such as the one offered by MedCerts, is the best way to prepare for the medical billing exam.

The MedCerts tuition advantage allows education to fit any budget.

All students have the option to pay in full, opt for monthly payment options, or obtain government funding in order to access the program. With payment options starting at $116 per month, you can give yourself a big career advantage for a small investment. In addition, army credentialing assistance and workforce grants are also available to active and retired military members.

Enrolling in the program is easier than ever.

If you have a high school diploma or GED, you've already taken the most significant step toward eligibility. You'll also need a web browser with a reliable internet connection. Once you complete your course registration and select your payment option, you'll be ready to get started.

All program materials are included with your enrollment.

Over the course of 14 weeks, you'll complete three courses: Professionalism in Allied Health, Intro to Human Anatomy and Medical Terminology, and Insurance, Billing, and Coding Essentials. No need to save up for books and study materials—when you enroll with MedCerts, you get access to everything you need, including:

  • Expert-led video-based training

  • Competency assessments

  • National Certification exam fee

  • Required eBook: Medical Insurance, a Revenue Cycle Process Approach

Medical Billing Exam FAQs

How much money can you make as a medical billing specialist?

Medical billing specialists can expect a starting salary between $25,000 and $51,000, with the career potential of becoming a physician biller and reaching up to $90,000.The MCBC exam helps prepare you to achieve these long-term goals with the necessary skill and confidence.

How hard is the MCBC exam to pass?

The medical billing exam has a pass rate of 73%, so you'll need to prepare appropriately and ensure you understand the material. The best way to do this is through MedCerts' comprehensive medical billing certification course.

How much does the medical billing exam cost?

The MCBC exam fee is $109. However, MedCerts students can skip paying this cost, as it is included in the tuition price.

How many questions are on the medical billing exam?

The exam consists of 100 multiple-choice questions. You'll have 2 hours to complete the exam.

What happens if you fail the exam?

If you fail to pass the exam on your first attempt, you can re-register to retake it. You will need to pay the registration fee ($109) for each additional time. Preparing and studying thoroughly for the exam before attempting it a second time is vital.

What jobs can you get with a medical coding and billing certification?

Medical Biller ($25K - $51K)

Medical billers collect and analyze patient information to ensure the accuracy of billing. They also follow up on unpaid medical bills and help develop payment plans with patients.

Medical Insurance Specialist ($32K - $66K)

Medical insurance specialists review patient information to determine if a claim is eligible for coverage. They also process medical claims, code documents, and answer customer questions about payment policies.

Physician Biller ($30K-$90K)

Physician billers work directly with physicians and may supervise other billing staff and handle complex issues related to billing and coding.

Your New Career in Medical Billing Awaits

The MedCerts Medical Billing & Coding program is the perfect way to jump-start your career in medical billing. With expert instructors, comprehensive materials, and national certification help, you can be sure you're getting the best training available. Learn more about how MedCerts can propel your career forward today.

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Published on September 30, 2022