ED-MHC-103 Electronic Health Records Specialist with Medical Billing

Electronic Health Records

After completing this course, you should be able to:

• Identify the developmental challenges associated with creating electronic health records
• Define electronic health record and its advantages and disadvantages
• Recognize the importance of patient data privacy
• List the steps for basic coding techniques
• Name the steps for documenting in the EHR

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

Electronic Health Records

Electronic Health Records Module 1
Introduction to the Electronic Health Record

• What is a Health Record?
• Who Documents in the Health Record?
• Who Owns the Health Record?
• The Electronic Health Record
• Advantages of Electronic Health Records
• Disadvantages of Electronic Health Records
• Role of the Healthcare Professional Using the Electronic Health Record
• Professional Organizations

Electronic Health Records Module 2
Overview of SimChart

• The Medical Practice and Electronic Health Records
• Accessing SCMO Through Evolve
• Getting Comfortable with Electronic Health Records
• SCMO Assignment View
• Features in SCMO
• Establishing and Maintaining a Patient Registry
• Internet Use in the Medical Practice

Electronic Health Records Module 3
Privacy, Confidentiality and Security  

• HIPAA Law
• Confidentiality vs. Privacy
• Security Safeguards for the Medical Practice
• Patients’ Rights Under HIPAA
• Access to Protected Health Information
• Patients Protecting Health Information

Electronic Health Records Module 4
Administrative Use of the Electronic Health Record

• Role of the Front Office Assistant
• Communication in the Medical Office
• Incident Reports
• Managing Electronic Health Records
• Calendar

Electronic Health Records Module 5
Clinical Use of the Electronic Health Record   

• Documentation in the Electronic Health Record
• Clinical Documentation in the Patient Record
• Tracking Health Screenings and Immunizations
• Using the Electronic Health Record for Patient Education
• The Progress Note

Electronic Health Records Module 6

Using the Electronic Health Record for Reimbursement

• Healthcare Reimbursement
• Revenue Cycle
• Coding Systems
• HCPCS
• Pay for Performance
• SuperBill
• Patient Ledger
• HIPAA 5010 Claim Processing
• Medical Necessity
• Fraud and Abuse
• Patient Statements
• Reporting Features of an EHR

Electronic Health Records Module 7

The Personal Health Record and Patient Portals

• What is a Personal Health Record?
• Innovative Features of Personal Health Records
• Benefits to Providers
• Steps in Creating the Personal Health Record
• Maintaining the Personal Health Record
• Patient Portals

**Outlines are subject to change, as courses and materials are updated.**

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.**

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