- Description
- Objectives
- Outline
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- Certification
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Our Medical Billing & Coding Specialist program prepares individuals for a rewarding career in the medical field. Billing and Coding Specialists are an intricate part of all medical practices and are primarily responsible for organizing patient files and making sure that notes about exams and treatment regimens are accurate and accessible, process payments, including sending out bills and dealing with insurance claims. Our training begins with Medical Terminology; common medical terminology is a critical part of the language used by health care practitioners. It is essentially a vocabulary that requires a uniform pronunciation, definition, and spelling of terms used by professionals. Individuals with medical terminology training are capable of analyzing and interpreting medical reports related to specific body systems. Both Medical Billing and Medical Coding track to the national exam and prepare students for a successful career in medicine.
Medical Billing
After completing this course, you should be able to:
- Identify the core elements of health insurance
- List features of the different coding systems and their documentation
- Define the features of processing claim forms both electronic and paper
- Recall the basics of fee and insurance collection
- Recognize the features of various health care payer types
Medical Coding
After completing this course, you should be able to:
- Identify the core elements of the ICD-10-CM coding system
- Recognize the conventions and guidelines of the ICD-10-CM coding system
- List the conventions and guidelines of the HCPCS coding system
- Define the fundamental uses and guidelines of the CPT coding system
- Recall the use of modifiers and evaluation and management services (E/M)
Medical Terminology
After completing this course, you should be able to:
- Identify how to gain and understand the basic word structure in medical terminology
- Recognize how to relate the medical terms to the structure and function of the human body
- Identify body systems, body cavities, and planes of the body
- Define words by dividing them into their component parts
- Recall the terminology used with medical specialists and case reports
Medical Billing
Medical Billing Module 1
Basics of Insurance Billing and Compliance
- Insurance Billing Specialist
- Insurance Claims, Coding, & Billing Background
- Medical Etiquette
- Medical Ethics
- Health Insurance Portability and Accountability Act (HIPAA)
- Fraud and Abuse Laws
- Compliance Programs
- Health Care Reform
- Insurance Policies
Medical Billing Module 2
Basics of Health Insurance
- History of Health Insurance in the United States
- Health Care Reform
- Types of Health Insurance Coverages
- Private Health Insurance
- Managed Care Systems
- Financial Management
- Medicare
- Policies and Regulations
- Medicare Reimbursement
- Claim Submission
Medical Billing Module 3
State Programs and Veterans’ Health Care
- Medicaid Programs
- Medicaid Eligibility
- Medicaid Benefits
- Medicaid Managed Care
- TRICARE
- History of Tricare
- Health Plans
- Veterans Health Administration Program
Medical Billing Module 4
Workers’ Compensation and Disability Programs
- Workers’ Compensation Laws and Insurance
- Types of State Compensation Benefits
- Fraud and Abuse
- Legal Situations
- Reporting Requirements
- Disability Claims
- Disability Income Insurance
- Federal Disability Programs
- State Disability Insurance
- Voluntary Disability Insurance
Medical Billing Module 5
Documentation and Coding for Professional Services
- Documentation Process
- Electronic Health Records
- Health Record Documentation
- Review and Audit of Health Records
- Diagnostic Coding
- Official Guidelines for ICD-10-CM
- Procedural Coding
- Current Procedural Terminology Content and Format
- Code Modifiers
Medical Billing Module 6
Claims Submission in the Medical Office
- The Paper Claim CMS-1500
- Types of Submitted Claims
- Health Insurance Claim Form (CMS-1500)
- Claim Completion Guidelines
- Electronic Claims
- Clearinghouses
- Claim Attachment Standards
- Practice Management System
- Computer Claims Systems
Medical Billing Module 7
The Claim Follow-Up and Payment Process
- Revenue Cycle Management
- Claim Policy Guidelines
- Explanation of Benefits
- Claim Management Techniques
- Rebilling
- Review and Appeal Process
- Filing an Appeal
- Collection Strategies
- Accounts Receivable
Medical Billing Module 8
Healthcare Facility Billing
- Ambulatory Surgery Centers
- Payment Systems
- Payment Rates
- Revenue Cycle Management
- Medical Records for Reimbursement
- Hospital Outpatient and Inpatient Billing
- Employment Opportunities
- Self-Employment
**Outlines are subject to change, as courses and materials are updated.**
Medical Coding
Medical Coding Module 1
Overview of ICD-10-CM
- Reimbursement, HIPAA and Compliance
- Basic Structure of the Medicare Program
- Improvements to the ICD-10-CM
- ICD-10-CM Format
- Mapping
- Outpatient Coding and Reporting Guidelines
- Unconfirmed Diagnosis
- Z Codes
- Chronic Diseases
- Therapeutic Services
Medical Coding Module 2
Using ICD-10-CM
- Accurate Coding
- Alphabetic Index and Tabular List
- Level of Specificity
- Integral Conditions
- Multiple Coding
- Chapter Specific Guidelines Chapters 1-10
- Endocrine, Nutritional and Metabolic Diseases
- Diseases of the Nervous System
- Diseases of the Circulatory System
- Diseases of the Respiratory System
Medical Coding Module 3
Chapter-Specific Guidelines
- Diseases of the Digestive System
- Diseases of the Skin and Subcutaneous Tissue
- Diseases of the Musculoskeletal System and Connective Tissue
- Pregnancy, Childbirth and Puerperium
- Congenital Malformations, Deformations and Chromosomal Abnormalities
- Symptoms, Signs and Abnormal Clinical and Laboratory Findings
- Injury and Poisoning
Medical Coding Module 4
CPT, HCPCS and Modifiers
- The Purpose of the CPT Manual
- Updating the CPT Manual
- CPT Manual Format
- Level II National Codes (HCPCS)
- History of National Level Codes
- Updating the HCPCS Manual
- National Physician Fee Schedule
- CPT Modifiers
Medical Coding Module 5
E/M Services and Anesthesia
- Contents of the E/M Section
- Three Factors of E/M Codes
- Various Levels of E/M Service
- An E/M Code Example
- Using the E/M Codes
- Documentation Guidelines
- Types of Anesthesia
- Anesthesia Section Format
- Formula for Anesthesia Payment
- Concurrent Modifiers
Medical Coding Module 6
Surgery Guidelines and Integumentary System
- Surgery Section
- Notes and Guidelines
- Special Reports
- Separate Procedure
- Surgical Package
- Skin, Subcutaneous and Accessory Structures
- Burns
- Destruction
- Breast Procedures
Medical Coding Module 7
Musculoskeletal and Respiratory Systems
- Fractures and Dislocations
- Application of Casts and Strapping
- Endoscopy
- Arthroscopy
- Accessory Sinuses
- Larynx
- Trachea
- Bronchi Lungs and Pleura
Medical Coding Module 8
Cardiovascular, Hemic, Lymphatic and Digestive Systems
- Cardiovascular Coding in the Surgery Section
- Cardiovascular Coding in the Medicine Section
- Cardiovascular Coding in the Radiology Section
- Hemic and Lymphatic Systems
- Mediastinum and Diaphragm
- Lips
- Vestibule of Mouth
- Salivary Glands and Ducts
- Pharynx, Adenoids and Tonsils
- Intestines
Medical Coding Module 9
Urinary, Reproductive and Genital Systems
- Urinary System
- Male Genital System
- Intersex Surgery
- Reproductive System Procedures
- Male and Female Genital Systems
- Maternity Care and Delivery
Medical Coding Module 10
Endocrine System, Eye, Ocular Adnexa and Radiology
- Nervous System
- Auditory System
- Operating Microscope
- Radiology Terminology
- Diagnostic Radiology
- Breast Mammography
- Diagnostic Ultrasound
- Radiation Oncology
Medical Coding Module 11
Pathology/Laboratory, Medicine and Inpatient Coding
- Organ or Disease Oriented Panels
- Therapeutic Drug Assays
- Urinalysis, Molecular Pathology and Chemistry
- Immunizations
- Gastroenterology
- Allergy and Clinical Immunology
- Medical Nutrition Therapy
- Medication Therapy Management Services
- Differences between Inpatient and Outpatient Coding
- Present on Admission (POA)
**Outlines are subject to change, as courses and materials are updated.**
Medical Terminology
Medical Terminology Module 1
Basic Word Structure
- Word Analysis
- Combining Forms
- Suffixes & Prefixes
- Pronunciation of Terms
- Exercises & Applications
Medical Terminology Module 2
Organization of the Body
- Body Systems and Cavities
- Divisions of the Back
- Planes of the Body
- Pronunciation of Terms
- Exercises & Applications
Medical Terminology Module 3
Suffixes
- Introduction to Suffixes
- Suffixes and Terminology
- Diagnostic & Procedural Suffixes
- Pronunciation of Terms
- Exercises & Applications
Medical Terminology Module 4
Prefixes
- Combining Forms & Prefixes
- Prefixes and Terminology
- Define Common Prefixes
- Pronunciation of Terms
- Exercises & Applications
Medical Terminology Module 5
Medical Specialists & Case Reports
- Medical Specialists
- Combining Forms & Vocabulary
- Case Reports & Terminology
- Pronunciation of Terms
- Exercises & Applications
Medical Terminology Module 6
Body Systems – Part 1
- Cardiovascular System
- Digestive System
- Endocrine System
- Female Reproductive System
- Lymphatic System
Medical Terminology Module 7
Body Systems – Part 2
- Male Reproductive System
- Musculoskeletal System
- Nervous System
- Respiratory System
- Skin & Sense Organs
- Urinary System
**Outlines are subject to change, as courses and materials are updated.**
All course materials included.
Medical Billing & Coding
Upon successful completion of our Medical Billing & Medical Coding courses, students will be prepared to sit for the American Medical Certification Association's (AMCA) Medical Coder & Biller (MCBC) certification exam. Proof of course completion is required and applicants must pass the exam within one year from the date of training completion.
Note: This course is not affiliated with, nor has it been endorsed by the American Medical Certification Association (AMCA).
Internet Connection
- Broadband or High-Speed - DSL, Cable, and Wireless Connections
*Dial-Up internet connections will result in a diminished online experience. Classroom pages may load slowly and viewing large audio and video files may not be possible.
Hardware Requirements
- Processor - 2GHz Processor or Higher
- Memory - 1 GB RAM Minimum Recommended
PC Software Requirements
- Operating Systems - Windows 7 or higher
- Microsoft Office 2013 or higher. Also, you could use a general Word Processing application to save and open Microsoft Office formats (.doc, .docx, .xls, .xlsx, .ppt, .pptx)
- Internet Browsers - Google Chrome is highly recommended
- Cookies MUST be enabled
- Pop-ups MUST be allowed (Pop-up Blocker disabled)
- The Kindle Reader App or VitalSource Bookshelf App are needed for many of our courses (No special equipment needed. This can be downloaded for FREE onto your computer.)
- PowerPoint Viewer (if you do not have PowerPoint)
- Adobe PDF Reader
- QuickTime, Windows Media Player &/or Real Player
MAC Software Requirements
- Operating Systems - Mac OS x 10 or higher with Windows
- Mac office programs or a Word Processing application to save and open Microsoft Office formats (.doc, .docx, .xls, .xlsx, .ppt, .pptx)
- Internet Browsers- Google Chrome is highly recommended
- Cookies MUST be enabled
- Pop-ups MUST be allowed (Pop-up Blocker disabled)
- The Kindle Reader App or VitalSource Bookshelf App are needed for many of our courses (No special equipment needed. This can be downloaded for FREE onto your computer.)
- PowerPoint Viewer (if you do not have PowerPoint)
- Adobe PDF Reader
- Apple QuickTime Media Player
