Medical Billing and Coding Professional
 


DESCRIPTION:

This course thoroughly prepares students to code patients' medical records correctly and optimize reimbursement for a full range of medical services. Students are introduced to several techniques for finding and applying the correct codes in today's standard coding systems. Topics covered include: current procedural terminology, students will receive a certificate of completion.

Course Outline
Class 01: Introduction to Medical Billing & Coding
  • Job Roles and Duties
  • The Medical Team
  • Legal Issues
  • Fraud
  • HIPAA and Fraud and Abuse
  • Employee Bonding and Errors and Omission Insurance
  • Claim Audits
  • Medical Ethics
Class 02: Clinical Records & Medical Document
  • Medical Charts
  • Filing the Chart
  • Medical Documentation Rules
  • SOAP Notes
  • Signature Cards
  • Retention of Records
  • Storing Medical Records
  • Electronic Medical Charting
  • Computerized Files
  • Record Transfers
  • Patient Information Sheet
  • Release of Information Form
  • Assignment of Benefits Form
  • Patient History Form
  • Insurance Verification
Class 03: HEALTH INSURANCE PROGRAMS
  • Blue Cross/ Blue Shield
    • Blue Cross/ Blue Shield Plan
    • Blue Cross/ Blue Shield Claims
  • Tricare
    • Tricare Plan
    • Tricare Claim
  • Commercial Insurance
    • Commercial Insurance Plan
    • Commercial Insurance Claim
  • Medicare
  • Medicare Eligibility
  • The Parts of Medicare
  • Allowable Charges
  • Medicare Physician Identification Numbers
  • Medicare Billing Notices
  • Assignment of Benefits
  • Medicare Secondary Payer
  • 0Durable Medical Equipment
  • Medicare Denials
  • Advance Beneficiary Notice (ABN)
  • The Medicare Appeals Process
  • Medicare Fraud and Abuse
  • Medicare Supplemental Insurance
  • Medicare and Managed Care
  • Medicare Notice of Non-Coverage
  • Medicare Billing Guidelines
  • Medicaid
  • Medicaid Covered Services
  • Reimbursement from Medicaid
  • Medicaid as Secondary Payer
  • Treatment Authorization Request
Class 04: Workers' Compensation
  • System
  • Time Limits
  • Fraud and Abuse
  • Types of Workers' Compensation Benefits
  • Patient Records
  • Doctor's First Report of Injury/Illness
  • Progress Reports
  • Delinquent Claims
  • Workers' Compensation Appeals
Class 05: FINANCES & ACCOUNTING (Medical Practice Accounting)
  • Patient Accounting
  • Accounts Payable/Receivable
  • Patient Ledger Card/Statement of Account
  • Insurance Payments
  • Patient Payments
  • Posting Payments
  • Balance Billing
  • Follow-Ups
  • Collections
  • Collections Procedures
  • Small Claims Court
  • Practice Accounting
  • Petty Cash
  • The Day Sheet/Daily Journal
  • Office Reports
Class 06: MEDICAL CODING
  • ICD-10-CM
  • CPT
  • HCPCS Level II Codes, Determining & Assigning
  • International ification of Disease (ICD-10-CM) Coding
    • Overview ICD-10-CM
    • Contents of the ICD-10-CM
    • How to Use the ICD-10-CM Index & Tabular List
    • General Guidelines
    • Main Terms
    • V Codes
    • E Codes
    • Signs and Symbols Used in the ICD-10-CM
    • ICD-10-CM Coding in Future
  • Current Procedural Terminology (CPT) Coding
    • Using the CPT
    • Semicolons in the CPT
    • Signs and Symbols Used in the CPT
    • CPT Index
    • CPT Modifiers
    • National Corrective Coding Initiative
    • Evaluation and Management Codes Section
    • Anesthesia Section
    • Surgery Section
    • Radiology/X-ray Section
    • Pathology/Laboratory Section
    • Medicine Section
  • Rhythms Originating from the Atrial-Junction Node
    • Junctional Rhythm
    • Supraventricular Tachycardia
Class 07: MEDICAL BILLING (CMS-1500 Form and Medical Billing Procedures)
  • Superbill
  • CMS-1500 Form
  • CMS-1500 Block Explanations
  • 1500 Health Insurance Claim Form
  • Patient Claim Form
  • Billing for Services
  • Determining the Proper Billing Amount
  • Special Services
  • Claims Submission Process
  • Clean Claims
  • Coordination of Benefits
  • Health Maintenance Organizations
  • Collecting the Patient Portion
  • TRICARE
  • Billing Reports
  • Prompt Payment Laws
  • Tracer Claims/Delinquent Claims
  • Denied Claims
  • Resubmission of Claims
  • Adjusted Claims
  • Review and Appeals
  • Balance Billing Patients for Down-coded or Denied Claims
The UB-92 Form and Hospital Billing Procedures
  • Uniform Bill (UB-04)
  • Assignment of Benefits
  • Charge master Descriptions
  • Entering Charges
  • Preauthorization, precertification and utilization reviews
  • Abstracting, Billing, & Coding Form Medical Reports
    • Abstracting from Medical Records
    • Triage Reports
    • Operative Reports
    • Diagnostic Testing Reports
    • Medical History and Physical Examination Reports
Class 09: PROVIDER & MEDICAL ABBREVIATIONS
  • Medical Abbreviations & Terminology
  • FORMS
    • Patient Information Sheet
    • Insurance Coverage Form
    • Patient Claim Form
    • Superbill/Charge Slip
    • Insurance Claim Register
    • CMS-1500 Claim Form
    • UB-92 Billing Form
    • Hospital Admission Form