Medical Billing and Coding

Medical Billing & Coding

After completing this course, you should be able to:

• Identify information about major insurance programs and federal health care legislation
• Describe the basic knowledge of national diagnosis and procedure coding systems
• Recall CMS reimbursement methodologies
• List codes for medical necessity
• Define the billing processes for various government, commercial, and private insurances

Medical Terminology: An Overview

After completing this course, you should be able to:

• Identify the foundation of medical terminology
• List functions of major body systems such as skeletal, muscular and sensory
• Recall how your blood vessels, lymph nodes and heart work together
• Recognize the fundamentals of the body’s endocrine system, central nervous system and the male and female reproductive systems

Medical Billing & Coding

Medical Billing & Coding Module 1
Origins of Health Insurance

• What is Insurance?
• Key Health Insurance Issues
• Basic Health Insurance Plans
• Job Duties and Responsibilities
• Career Prospects
• What to Expect as a Health Insurance Professional

Medical Billing & Coding Module 2
Legalities and Healthcare Reform

• Medical Law and Liability
• Insurance and Contract Law
• Medical Ethics and Etiquette
• Medical Health Record
• Documentation and Maintenance of Records
• Confidentiality and Privacy
• Healthcare Fraud and Abuse
• Changing Face of Health Insurance
• Major Healthcare Payers
• CMS-1500 Claim Form
• Third-Party Carriers

Medical Billing & Coding Module 3
The Billing Process and Reimbursement Models

• HIPAA Requirements
• Billing Policies and Practices
• Billing and Collection
• Laws Affecting Credit and Collection
• Billing Services
• Types of Health Insurance
• Standard Costs Associated with Insurance Plans
• How Fees Are Determined
• Affordable Care Act and HIPAA
• Commercial or Private Health Insurance
• Submitting Commercial Claims

Medical Billing & Coding Module 4
Managed Care and Medicare

• Origins and Goals of Managed Care
• Types of Managed Care Organizations
• Managed Care and Government Sponosered Health Plans
• Managed Care and HIPAA
• Managed Care and Affordable Care Act
• Claims Management
• Medicare Program
• Medicare Combination Coverages
• Medicare and Managed Care
• Medicare Billing
• Using the CMS-1500 Form for Medicare Claims
• Medicare Audits and Appeals
• Medicare Billing Fraud

Medical Billing & Coding Module 5
Medicaid and Military Carriers

• Medicaid and Healthcare Reform
• Medicaid Benefits
• Dual Eligible Beneficiaries
• Medicaid Premiums and Cost-Sharing
• Prescription Drugs
• Emergency Medical Treatment and Labor Act
• Processing Medicaid Claims
• Medicaid and Third-Party Liability
• TRICARE Coverage
• TRICARE Claims Processing
• CHAMPVA Program Options and Benefits

Medical Billing & Coding Module 6
Miscellaneous Carriers and Claims Submission

• Workers’ Compensation
• Private and Employer-Sponsored Disability Income Insurance
• Federal Disability Programs
• SSI Work Incentives
• Electronic Claims
• Health Insurance Portability and Accountability Act
• HIPAA Version 5010 Transactions and Code Standards
• Universal Claim Form (CMS-1500)

Medical Billing & Coding Module 7
Diagnostic Coding

• International Classification of Diseases Coding System
• History and Development of ICD
• Overview of the ICD-10 Coding System
• Coding Steps for the Alphabetic Index
• Tabular List
• ICD-10-CM Official Guidelines for Coding and Reporting
• HIPAA and Coding
• Looking Ahead to ICD-11

Medical Billing & Coding Module 8
Procedural, Evaluation and Management, and HCPCS Coding

• Overview of Current Procedural Terminology Coding
• Two Levels of Procedural Coding
• Current Procedural Terminology Manual Format
• Conventions and Punctuation Used in Current Procedural Terminology
• Evaluation and Management Coding
• Modifiers
• Overview of HCPCS
• HIPAA and HCPCS Coding

Medical Billing & Coding Module 9
Claims Management

• Overview of the Claims Management Process
• HIPAA and National Standard Employer Identification Number
• Claims Process
• Processing Secondary Claims
• Appeals
• Impact of Computers on Health Insurance
• Role of HIPAA on Electronic Transmissions
• Electronic Claims Process

Medical Billing & Coding Module 10
Reimbursement and Hospital Billing and the UB-04

• Understanding Reimbursement Systems
• Medicare and Reimbursement
• Hospitals and Health Systems
• Common Healthcare Facilities
• Legal and Regulatory Environment
• Common Hospital Payers and Claims Guideline
• Structure and Content of the Hospital Health Record
• Inpatient Hospital/Facility Coding
• Outpatient Hospital Coding
• Hospital Billing Process
• Billing Compliance

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

Medical Terminology: An Overview

Medical Terminology: An Overview Module 1 
Prefixes, Roots, and Suffixes

Module one will take a look at the basics of body anatomy and organization, the foundation of medical terminology and why words are structured the way they are. We will look at the relationship between Greek and Latin roots, prefixes, suffixes and everyday pronunciation.

• History of Medical Terminology
• Applying Different Rules of Pluralization
• Deconstructing Medical Words
• Pronunciation and Everyday Usage 
• Organization of the Body

Medical Terminology: An Overview Module 2 
Bones, Muscles, Skin and Sensory

Module two discusses the major body systems such as skeletal, muscular and sensory and their root terminology. We will cover how systems function together and how they correlate to the overall health of the human body, as well as pathology, diseases and conditions that affect these systems.

• Terminology of the Skeletal, Muscular, Integumentary and Sensory Systems
• Skeletal Diseases and Pathology
• Classes and Types of Muscles
• Skin Layers and Conditions
• Anatomy of Eyes, Ears and Nose

Medical Terminology: An Overview Module 3 
Heart, Lungs and Gastrointestinal

Module three covers how your blood vessels, lymph nodes and heart all work together, as well as how the respiratory system and organs of the digestive system function. We will also recognize the proper way to diagnose gastrointestinal and respiratory conditions according to the specific body part.

• The Cardiovascular and Lymphatic Systems
• Veins, Arteries and Blood Flow
• Organs of the Digestive System
• Gastrointestinal Diseases and Pathology
• Respiratory Terminology and Diagnostic Tests

Medical Terminology Module 4
Hormones, Nerves, Urinary and Reproductive

Module four discusses the fundamentals of the body’s endocrine system, the central nervous system and the male and female reproductive systems. We will also cover easy methods and simple phrases for memorizing medical terms through study guides and tips and tricks.

• Endocrine System and Hormone Functions 
• Parts of the Central Nervous System
• Urinary Tract Functions
• Male Reproductive Systems
• Female Reproductive Systems

Medical Billing & Coding

Upon successful completion of our Medical Billing & Coding course, students will be prepared, in part, for an entry-level position in a medical office setting and will be prepared to sit for the NHA national certification exam to become a Certified Billing and Coding Specialist (CBCS).

** Certification exams are not included in the cost of the course.**

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