What is a Healthcare Compliance Certification and Why Pursue It?

Healthcare compliance is a dynamic field, one which demands professional excellence, continuing education, and a proactive approach. Healthcare compliance certification exists to confirm that compliance professionals have the knowledge, commitment, and competence to stay on top of all possible compliance issues. While it’s not a requirement to practice, more employers are beginning to ask for professional certification as a prerequisite for employment.

Healthcare compliance certification is broken into three stages: eligibility, testing, and renewal. The eligibility stage confirms that a candidate has the necessary educational and/or work experience in the field of healthcare compliance. The testing stage usually involves an exam that’s broken down into key knowledge areas and their practical applications. The renewal stage, which ranges from one to three years, serves to confirm that a certified healthcare compliance professional has completed a designated amount of continuing education, and therefore stayed abreast of evolving issues and regulations within the industry.

The Affordable Care Act (ACA) states that compliance programs are a mandatory condition of enrollment in federal healthcare programs like Medicare and Medicaid. For professionals working in those programs, certification can help mitigate compliance-related risks. For professionals working in other areas of healthcare compliance, certification is a way to demonstrate excellence and a commitment to continuous learning.

Healthcare compliance certification is a step beyond the bachelor’s or master’s level, and many professionals choose to seek it out after accruing at least a year of experience in the field. But experience alone is not necessarily enough to prepare a candidate for the testing portion of the certification process. Some candidates choose to enroll in advanced graduate certificate courses in healthcare compliance, such as the one at Northwestern University, to prepare themselves. Such programs, along with certification, ensure that healthcare compliance professionals are fully trained in the myriad rules and processes of contemporary healthcare compliance.

To get a look at the different types of certifications available for healthcare compliance professionals, read on.

The Compliance Certification Board (CCB), partnered with the Health Care Compliance Association (HCCA), is the premier credentialing agency in the healthcare compliance industry. They offer several certifications, each of which corresponds to a particular area of experience within the industry.

The Certified in Healthcare Compliance (CHC) designation is for healthcare compliance professionals of all levels. The Certified in Healthcare Research Compliance (CHRC) designation is for healthcare compliance professionals with a research focus, while the Certified in Healthcare Privacy Compliance (CHPC) designation is for healthcare compliance professionals with a privacy focus.

Applicants must have at least one year in a full-time compliance position or 1,500 hours of direct compliance job duties within the last two years; those applying for the CHC designation may instead demonstrate completion of a CCB-accredited certificate program in the last two years. All applicants must have completed 20 CCB continuing education units, ten of which must come from live training events, and earned within the last year.

Once deemed eligible, candidates will need to pass a two-hour, 120-question exam. While each credential has its own domain-specific exam, each is split into the same seven knowledge areas: standards; policies and procedures; communication, education, and training on compliance issues; compliance program administration; discipline for non-compliance; screening and evaluation of employees, vendors, physicians, and other agents; monitoring, auditing, and internal reporting systems; and investigations and remedial measures. Only 100 questions are scored.

Exam fees for each credential are $275 for HCA members and $375 for non-members. Those who hold the CHC designation will need to recertify every two years by completing 40 CBB continuing education units, 20 of which must come from live training.

The American Academy of Professional Coders offers an alternative certification through its Certified Professional Compliance Officer (CPCO) credential. Individuals who hold the CPCO credential have demonstrated competence in all key areas of healthcare compliance.

CPCO candidates will need to be current members of the AAPC. While there is no experience requirement, the AAPC strongly recommends that candidates have at least two years of experience working with compliance programs and the associated laws and regulations. The AAPC also recommends candidates have at least an associate’s degree in a healthcare-related field.

In order to earn the CPCO credential, candidates must pass a 340-minute, 150-question exam that covers a wide variety of compliance topics: healthcare compliance program history; OIG compliance program guidance for physicians and small group practices; compliance program guidance for third-party billing companies and clinical laboratories; OIG supplemental compliance program guidance for hospitals; risk areas; fraud and abuse laws; other laws and regulations; investigations process and audits; and references and resources.

Exam fees are $399. CPCO-holders must renew their AAPC membership annually, and renew their credential every two years through the completion of 36 continuing education units.

Health Ethics Trust, as a division of the non-profit and non-partisan Council of Ethical Organizations, began offering compliance certifications in 1995. Its goal is to promote professionalism and competence throughout the healthcare compliance community.

Early-career compliance professionals who wish to distinguish themselves as meeting the industry standards of healthcare compliance can look to the Certified Compliance Professional (CCP) designation. Mid-career compliance executives can look to the Certified Compliance Executive (CCE) designation.

In order to earn the CCP designation, candidates will need to a total of 100 points from four areas: compliance-related experience (worth 30 to 150 points); educational background (worth 30 to 100 points); related education (worth 30 to 100 points); and an essay examination (worth up to ten points). There are a large number of different combinations one can use to meet the 100-point threshold, and precise details are available from the HET. Application fees total $150 for non-members.

In order to earn the CCE designation, candidates will need to earn a total of 170 points from five areas: compliance experience (worth 60 to 100 points); compliance community involvement (worth 20 to 100 points); education background (worth 50 to 100 points); continuing education (worth 30 to 100 points); and an essay examination (worth up to 10 points).

Again, there are a large number of different combinations one can use to meet the 100-point threshold, and precise details are available from the HET. Application fees total $150 for HET members and $300 for non-members.

Both CCP- and CCE-holders must recertify every three years through the accrual of 40 points of combined continuing education and work experience. Renewal fees are $75 for HET members and $150 for non-members.