Medical Billing and Coding Professional

Medical Billing and Coding Professional Course

COURSE 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

1. Blue Cross/ Blue Shield

• Blue Cross/ Blue Shield Plan
• Blue Cross/ Blue Shield Claims

2. Tricare

• Tricare Plan
• Tricare Claim

3. Commercial Insurance

• Commercial Insurance Plan
• Commercial Insurance Claim

4. Medicare
5. Medicare Eligibility
6. The Parts of Medicare
7. Allowable Charges
8. Medicare Physician Identification Numbers
9. Medicare Billing Notices
10. Assignment of Benefits
11. Medicare Secondary Payer
12. 0Durable Medical Equipment
13. Medicare Denials
14. Advance Beneficiary Notice (ABN)
16.The Medicare Appeals Process
17. Medicare Fraud and Abuse
18. Medicare Supplemental Insurance
19. Medicare and Managed Care
20. Medicare Notice of Non-Coverage
21. Medicare Billing Guidelines
22. Medicaid
23. Medicaid Covered Services
24. Reimbursement from Medicaid
25. Medicaid as Secondary Payer
Treatment Authorization Request

Class 04: Workers' Compensation

1. System
2. Time Limits
3. Fraud and Abuse
4. Types of Workers' Compensation Benefits
5. Patient Records
6. Doctor's First Report of Injury/Illness
7. Progress Reports
8. Delinquent Claims
9. Workers' Compensation Appeals

Class 05: FINANCES & ACCOUNTING (Medical Practice Accounting)

1. Patient Accounting
2. Accounts Payable/Receivable
3. Patient Ledger Card/Statement of Account
4. Insurance Payments
5. Patient Payments
6. Posting Payments
7. Balance Billing
8. Follow-Ups
9. Collections
10. Collections Procedures
11. Small Claims Court
12. Practice Accounting
13. Petty Cash
14. The Day Sheet/Daily Journal
15. Office Reports

Class 06: MEDICAL CODING

1. ICD-10-CM 2. CPT 3. HCPCS Level II Codes, Determining & Assigning 4. 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

5. 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

6. Rhythms Originating from the Atrial-Junction Node

• Junctional Rhythm
• Supraventricular Tachycardia

Class 07: MEDICAL BILLING (CMS-1500 Form and Medical Billing Procedures)

1. Superbill
2. CMS-1500 Form
3. CMS-1500 Block Explanations
4. 1500 Health Insurance Claim Form
5. Patient Claim Form
6. Billing for Services
7. Determining the Proper Billing Amount
8. Special Services
9. Claims Submission Process
10. Clean Claims
11. Coordination of Benefits
12. Health Maintenance Organizations
13. Collecting the Patient Portion
14. TRICARE
15. Billing Reports
16. Prompt Payment Laws
17. Tracer Claims/Delinquent Claims
18. Denied Claims
19. Resubmission of Claims
20. Adjusted Claims
21. Review and Appeals
22. Balance Billing Patients for Down-coded or Denied Claims

Class 08: The UB-92 Form and Hospital Billing Procedures

1. Uniform Bill (UB-04)
2. Assignment of Benefits
3. Charge master Descriptions
4. Entering Charges
5. Preauthorization, precertification and utilization reviews
6. 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

1. Medical Abbreviations & Terminology
2. 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