Medical Billing License
In 2025, medical billing and coding have become more complex, digitized, and compliance-sensitive than ever before. There has also been a shift toward more front-office environments, where financial workflows often begin. As insurance rules tighten, coding systems evolve, and billing models shift, front desk staff now handle tasks that the billing departments once handled. With key changes that took effect in 2025, understanding the role of medical billing in the office, the importance of medical billing certification, and whether a medical billing license is required to work in the industry are relevant topics if you are working in a medical office, supervising one, or thinking of joining one.
What Is Medical Billing?
Medical billing is the process of converting healthcare services into claims that are submitted to insurance companies for coverage and payment. It involves reviewing clinical documentation, assigning procedure-specific codes, ICD-10-CM and CPT/HCPCS codes, verifying coverage, submitting claims, managing reimbursements, and handling denials. Now, more front office staff are involved in critical steps for patients, such as eligibility verification, prior authorizations, and patient financial counseling, including taking payments. This places front office staff directly within the billing workflow, which has increased the desire for certification.
Changes to Medical Billing and Front Office Billing
Several recent changes, taking effect late 2024 and into 2025, have redefined billing roles.
Below are a few of the major medical billing changes:
- ICD-10-CM updates added 252 codes effective October 1, 2024, through September 30, 2025. This update also included 36 deletions and 12 revisions. (CDC and CMS)
- AMA introduced a new set of telemedicine codes. The 2025 CPT set added 17 telehealth-specific codes, which will change how remote care is reimbursed. (AMA new Telemedicine Codes)
- Centers for Medicare & Medicaid Services (CMS) 2025 Physician Fee Schedule also introduced tighter documentation rules for telehealth and evaluation/management coding (CTeL).
Additionally, there has been a shift from focusing on billing for the volume of services toward value-based care, where the emphasis is on supporting accurate diagnosis capture, risk adjustment, and quality outcomes. Nearly 14% of U.S. healthcare payments are now tied to value-based reimbursement models. This shift requires new billing protocols, payment models, and compliance tools that begin at patient intake. (Optum)
What’s the Difference Between Medical Billing and Coding vs. Medical Billing and Coding Specialist?
Medical Coder and Biller (CMCB)
The Medical Coder and Biller (CMCB) certification emphasizes diagnosis and procedure coding and financial billing. This certification equips you with a comprehensive understanding of the medical revenue cycle, from initial coding to final billing. This certification is for use in inpatient settings. It is ideal for those who want a broader role in healthcare operations.
With your CMCB, you will:
- Master coding systems like ICD-10, CPT, and HCPCS
- Understand the ins and outs of billing procedures and insurance policies
- Ensure compliance with regulatory guidelines for accurate billing
- Gain proficiency in medical terminology and patient record management
This certification is excellent for those who want to handle both coding and billing responsibilities and may open up a more comprehensive range of job opportunities within healthcare organizations.
Medical Coding and Billing Specialist (MCBS)
The Medical Coding and Billing Specialist (MCBS) certification focuses more on the coding aspect of the job, providing in-depth knowledge and skills necessary for accurate and compliant coding, and is more for outpatient settings with more specialty codes. While billing is part of the curriculum, the MCBS certification is ideal for individuals who want to concentrate more heavily on the coding side of medical documentation.
With your MCBS, you will:
- Develop a deep understanding of coding systems, with a focus on accuracy and compliance
- Specialize in coding for various medical fields, such as surgery, internal medicine, or pediatrics
- Focus on preventing coding errors that could result in denied claims or regulatory fines
- Enhance your ability to audit and review coding practices in healthcare settings
This certification is best for those who want to work primarily as medical coders, making sure healthcare providers receive the correct reimbursement for provided services.
Learn more on our AAH Blog – “Getting Your Medical Billing and Coding Certification.”
Is There a Medical Billing License?
No, there is no official federal or state-mandated medical billing license in the U.S. This means you do not need a government-issued license to begin a billing or coding career. However, many employers now require certification from a recognized agency, such as the CMCB and MCBS certifications offered by American Allied Health.
What Exists Instead of a Medical Billing License?
Industry-recognized certifications serve as the standard credential for medical billers and coders. Certifications such as AAH’s Medical Coding and Billing Specialist (MCBS) offer national validation of knowledge in diagnostic and procedural coding, HIPAA compliance, insurance claim processing, and proficiency in billing software. These certifications are often included as minimum requirements in job listings and are the standard for demonstrating competence in the role without the existence of a formal medical billing license.
What Has Changed with a Medical Billing License in 2025?
While licensure is still not required, expectations have shifted. As of 2025, employers often expect credentialed staff who can navigate new coding systems, value-based payment models, and AI-powered billing platforms. Job descriptions for front office, revenue cycle, and medical admin roles increasingly call for certification to ensure compliance with CMS rules, telehealth billing guidelines, and No Surprises Act requirements.
Changes in Front Office Medical Billing in 2025
The role of the front office has undergone significant changes in many offices. Staff are now expected to verify real-time insurance eligibility, generate patient cost estimates, manage authorizations, explain payer policies, and document consent, all of which must be done before clinical services are provided. These front-loaded responsibilities reduce claim denials, increase collections, and protect against billing errors. The front office has become an integral part of the revenue cycle, and clinics now rely on certified staff to maintain compliance and ensure financial performance.
Why AAH Certification Matters More Than Ever
In 2025, while there is still no formal medical billing license, the industry has shifted even further toward treating certification as the new standard. Compliance demands, technology integration, and patient-centric workflows have redefined the front office role, making training and certification essential. If you're looking to launch or advance a career in medical billing, especially in a front-facing role, now is the time to become certified as a Medical Coding and Billing Specialist through AAH.
Your Training, Our Certification - Empowering Healthcare Professionals for a Stronger Tomorrow.
AAH Online Exam Benefits
American Allied Health (AAH) offers a convenient and affordable path to earning your certification on your schedule, making it easier to fit into your busy life. Below are several benefits of certifying through AAH:
- Affordable: AAH provides cost-effective, affordable certification, making getting certified accessible and starting or advancing your healthcare career easier. Enjoy free study materials, a free retake exam, and renewal fees that are 50% lower than industry standards.
- Streamlined Process: Register, submit documents, and receive your certification card in as little as one business day.
- Comprehensive Preparation: AAH provides extensive topical study guides and practice tests to ensure readiness. When you register for your online exam, you gain access to these free study materials and practice exams to help you prepare for your exam so you can certify with confidence. With several certifications, you also have the option to purchase a Premium Study Guide for a small fee as a refresher if you need it!
- 100% Online Testing: AAH's fully online program is designed for flexibility and ease. Study from anywhere, on your schedule. Convenient online exams that allow you to earn your certification onsite at your school, at your employer’s office, or from home, on your schedule. This allows you to certify when it's most convenient and not lose time from work or personal commitments. Earn the same credentials from the comfort of your own computer.
- Computer & Tablet Friendly: Study anytime, anywhere, and take the exam whenever you're ready.
- Nationally Recognized Credentials: Join over 50,000 certified professionals working in every U.S. state and more than 30 countries worldwide.
- Instant results: Immediate proof of certification for employers.
- One Free Retake: If you don't pass the exam on your first attempt, don't worry. AAH offers one free retake to ensure you have the opportunity to earn your certification.
- Continuing Education: AAH offers online CE courses, so you can earn your CE credits on your schedule and be ready to go when it comes time to renew. In your account, you can access all the Continuing Education (CE) credits you need to maintain your certification with AAH.
- Easy Renewal: AAH makes renewing your certification easy. Complete your continuing education, pay the renewal fee, and submit it within your AAH account to finalize the process.