Medical Billing & Coding

Medical Billing & Coding

Course Hours: 
275
Price: 
$1,250.00
Course Type: 
Mentor Supported
  • Description
  • Objectives
  • Outline
  • Materials
  • Certification
  • System Requirements
  • Watch a Demo

Accurate processing of health insurance claims has become more challenging and demanding as health insurance plan selections have rapidly expanded. These variations, combined with adjustments in state and federal regulations affecting the health insurance industry, are a perpetual task to health care personnel. Those responsible for processing health insurance claims require methodical instruction in all dimensions: abstracting of source documents, accurate completion of claims, and coding of diagnoses and procedures/services.  Our Medical Billing and Coding course provides students with the required information in a clear and comprehensive manner. In addition, students will be introduced to the latest code sets and guidelines and important topics such as managed care, legal and regulatory issues, coding systems, reimbursement methods, medical necessity, and common health insurance plans. 

 

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 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.**

Ed4Career is committed to being both environmentally conscious and making it easier for you to study! We’re making your education mobile! All of our textbooks are now provided as eTextbooks. You can access them on your laptop, tablet, or mobile device and can study anytime, anywhere.

The move away from physical books to eTextbooks means you get the latest, most up-to-date version available. This also makes your training more accessible, so you can study anywhere you have your phone or tablet. The best part is that all materials are included in your training cost so there are NO extra fees for books!

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