Compliance Certifications: Which is Right for You and Your Team?

The healthcare sector is one of the most regulated industries globally. The US Department of Health and Human Services (HHS) enforces the Healthcare Information Portability and Accountability Act (HIPAA), which mandates (among many things) industry-wide protocols and standards for patients’ data protection and privacy. There are other laws, such as the Patient Protection and Affordable Care Act, that require healthcare organizations to implement effective compliance procedures for improving patients’ lives through federally funded healthcare programs. Failure to comply with these standards can lead to high penalties and severe legal ramifications. For instance, according to the U.S. Department of Health & Human Services, violations of the Health Information Technology for Economic and Clinical Health (HITECH) Act can lead to a penalty of as high as $1.5 million for an organization.

This is why there’s always a huge demand for professionals who have healthcare compliance certification to help facilities and organizations navigate the complex and ever-evolving world of healthcare regulations that set standards for patients’ information privacy, prevent fraud, and ensure them quality healthcare services.

Is it the Right Career Option for You?

If you’re already working in the healthcare industry and have qualities like being detailed-oriented, an investigative mindset, problem-solving, reasoning skills, integrity, and a penchant for working with technologies, this could translate into a rewarding and well-paying career. A study revealed that the average wages of compliance managers in 2020 stood at $116,350 per annum. Employment growth is projected at 5%-10% between 2020 and 2030. Enrolling in the right healthcare compliance certification program can enhance your career prospects. Some distinctive advantages of certifications include enhancing your professional credibility, equipping you with broad-based knowledge and skills for steering your organization through regulatory complexities, and gaining over your peers. They also ensure that you take a proactive and comprehensive approach in a high-risk and challenging industry.

Given that healthcare is a highly regulated industry, you might be bombarded with various acronyms when choosing from certifications. It’s easy to get confused with so many options. Here, we look at some of the best healthcare compliance certification programs and how they can be right for you and your team.

Certified in Healthcare Compliance (CHC)

The Compliance Certification Board (CCB), in association with the Health Care Compliance Association (HCCA), offers several healthcare compliance certification programs. One of them is the CHC designation. If you wish to pursue a career in the general healthcare compliance sector, such as helping healthcare facilities to establish effective compliance programs, understanding and addressing legal obligations, and promoting organizational integrity through proper processes, this could be an option for you.

Eligibility Criteria for CHC

All applicants must have 20 CCB-approved continuing education units (CEUs), of which 10 need to come from live training events in the past year. There are also requirements for either work experience in a full-time compliance position or equivalent student experience. This certificate is valid for 2 years.

Once deemed eligible, you need to apply for the exam, after which your application will be reviewed and processed within 5 days. Following this, you need to schedule a test and appear for it in the given eligibility period.

Certified Professional Compliance Officer (CPCO) 

The American Academy of Professional Coders (AAPC) provides one of the best healthcare compliance certification programs called CPCO. The CPCO program is designed to help healthcare professionals develop an understanding of all requirements needed to design, enforce and monitor a healthcare compliance program, in varied settings.

The CPCO examination could be suited for you if you have experience in a compliance department, know some hcc medical coding tips, and are familiar with the day-to-day aspects of operating compliance programs. You have to be familiar with key regulations and laws that impact compliance programs, physician facilities, and those that deal with potential fraud and abuse. More than $1.8 billion worth of settlements of a total $2 billion settlements recovered by the US Department of Justice from the False Claims Act in 2020 comes from the healthcare industry. It is not surprising that the role of a CPCO-certified professional is extremely important. With this certification, you will be able to demonstrate your knowledge of handling investigations, the effectiveness of compliance programs, various risk areas, staff education, and more.

You could also be earning an attractive salary. According to a report, in 2021, CPCOs earned an average of $80,550 annually, much more than certified coders and billers.

Eligibility Criteria for CPCO

Candidates need to be current members of the AAPC, and the membership needs to be renewed annually. CPCOs need to have 80 hours of healthcare compliance training, designed for certified coders and students with equivalent experience. After that, they need to register and appear for the CPCO certification exam.

The CPCO credential is valid for 2 years, after which applicants must submit proof of completion of 36 continuing education units for authentication and verification of the credential.  

Certified in Healthcare Privacy and Security (CHPS)

Data protection has gained importance, making it critical for organizations to adopt stringent data privacy and security measures. Laws like HIPAA make it essential for healthcare facilities to hire highly trained privacy and security professionals.

The CHPS credential offered by the American Health Information Management Association (AHIMA) is one of the most recognized in the industry. With this certification, you can demonstrate your competence in designing, enforcing, and monitoring healthcare privacy and security programs in all types of healthcare settings.

Eligibility Criteria for CHPS

Applicants need to satisfy one of the following criteria to be eligible for the CHPS exam:

• High school or General Education Degree (GED) and at least 6 years of experience in healthcare privacy and security management.
• Associate’s degree and a minimum 4 years of experience in the field.
• Credentials like CCA, CCS, CCS-P or RHIT, along with at least 4 years of experience in the field.
• Master’s degree or a higher academic credential, with at least 1 year of experience in the field.
• RHIA and a minimum 2 years of experience.
• Baccalaureate degree, along with at least 2 years of experience.

Certified Compliance Professional (CCP)

Are you an early-career compliance professional who wishes to climb the ladder in the healthcare compliance sector? It’s a good idea to explore the CCP certification. This healthcare compliance certification is issued by the Health Ethics Trust for individuals working in the industry who wish to demonstrate a high level of professionalism to prospective employers.

Eligibility Criteria for CCP

To apply for this program, you need to have at least 1 year of active compliance experience and a letter of recommendation from your sponsor. This could be your immediate supervisor or a member of the board committee to which your compliance department reports. You also need a minimum educational qualification starting from an associate’s degree or equivalent. You must complete a certain portion of related courses offered by the Council before applying for an essay-writing examination to earn the certificate.

In an ever-evolving regulatory and technological landscape, healthcare laws could continue becoming increasingly complex. The need for certified compliance professionals to lead the companies through these challenging times will only increase. These certifications can help you grow in this field by developing your knowledge base and skillset.