Medical Billing

Hours: 300 / Access Length: 12 Months / Delivery: Open, Mentor Supported
Retail Price: $1,695.00

Course Overview:

Medical Billing is listed as one of the fastest growing professions in allied health. The medical industry is experiencing a tremendous demand for individuals with knowledge of medical office operations, which includes diagnostic and procedural insurance forms processing.

This Medical Billing course covers all the plans that are most commonly encountered in clinics and physicians' offices. An emphasis on the role of the medical insurance specialist prepares you for success in the workplace, including areas such as diagnostic coding, procedural coding, Medicare, HIPAA, and bill collection strategies. Our Medical Billing course will give you the skills you need to be competitive in the healthcare market place.

After completing this course, you should be able to:

• Comprehend the core elements of health insurance
• Identify features of the different coding systems and their documentation
• Define the features of processing claim forms both electronic and paper
• Comprehend fee and insurance collection
• Comprehend the features of various health care payer types

Course Outline:

Medical Billing Module 1
Career Role & Responsibilities

• Insurance Billing Specialist
• Insurance Claims, Coding, & Billing Background
• Medical Etiquette
• Medical Ethics
• Health Insurance Portability and Accountability Act (HIPAA)
• Using Electronic Technologies
• SNOMED
• The Privacy Rule
• Basics of Health Insurance
• Legal Principles of Insurance
• The Insurance Policy
• Choice of Health Insurance

Medical Billing Module 2
The Claims Process

• The Documentation Process
• Documentation Guidelines
• Contents of a Medical Report
• Review & Audit of Health Records
• The Diagnostic Coding System
• International Classification of Diseases
• Rules for Coding
• ICD-9-CM Versus ICD-10-CM
• Procedural Coding Skills
• Methods of Payment
• The CPT Code Book
• Code Modifiers

Medical Billing Module 3
Paper Claims and Electronic Data

• Types of Submitted Claims
• Health Insurance Claim Forms
• CMS-1500
• Why Claims are Delayed or Rejected
• Optical Scanning Format Guidelines
• Electronic Data Interchange
• Electronic Claims
• Transaction & Code Set Regulations
• Claims Attachment Standards
• Building the Claim
• HIPPA & Electronic Claims
• Records Management

Medical Billing Module 4
Fee & Insurance Collection

• Follow-Up After Claim Submission
• Claim Policy Provisions
• Explanation of Benefits
• Claim Management Techniques
• Review and Appeal Process
• State Insurance Commissioner
• Cash Flow Cycle
• Accounts Receivable
• Fee Schedule
• Credit Arrangements
• Credit & Collection Laws
• The Collection Process

Medical Billing Module 5
Health Care Payers, Part 1

• Private Insurance
• Managed Care Systems
• Medical Review
• Plan Administration
• Understanding Medicare
• Medicare Policies & Regulations
• Medicare Managed Care Plans
• Medicare Reimbursement
• Medicaid Programs
• Medicaid Eligibility
• Medicaid Benefits
• Medicaid Claim Procedures

Medical Billing Module 6
Health Care Payers, Part 2

• TRICARE Programs
• TRICARE Standards
• CHAMPVA Programs
• TRICARE & CHAMPVA Claims Procedures
• Workers’ Compensation Laws
• Workers’ Compensation Eligibility & Coverage
• Workers’ Compensation Fraud & Abuse
• Occupational Safety & Health Administration Act (OSHA)
• Disability Income Insurance
• Disability Benefit Programs
• Disability Claims
• Federal & State Disability Programs

Medical Billing Module 7
Inpatient & Outpatient Billing

• Hospital Billing
• Patient Service representative
• Admissions Procedures
• Utilization Review
• Coding Hospital Diagnoses & Procedures
• Coding Inpatient Procedures
• Coding Outpatient Procedures
• Reimbursement Process
• Billing Problems
• Hospital Billing Claim Form
• Employment Opportunities
• Searching for a Job
• Self-Employment

All necessary materials are included.

Certifications:

Upon successful completion of our Medical Billing course, students will be prepared for an entry-level position doing medical billing in a medical office setting and will be prepared to sit for the Med-Certification exam to become a Certified Medical Billing Specialist (CBS) or the AAPC certification exam to become a Certified Professional Biller (CPB).

System Requirements:

• Cable and DSL internet connections are recommended for the best experience.

• CPU: 1 GHz or higher
• RAM: 2 GB or higher
• Resolution: 1280 x 720 or higher
• Speakers / Headphones
• Microphone (Webinar / Live Online sessions)

• Microsoft Windows 7 or 10 (Home, Pro)
• Mac OSX 10 or higher.
• Latest Chrome OS
• Latest Linux Distributions

NOTE: While we understand that our courses can be viewed on Android and iPhone devices, we do not recommend the use of these devices for our courses. The size of these devices do not provide a good learning environment for students taking online or live online based courses.

• Latest Google Chrome is recommended for the best experience.
• Latest Mozilla FireFox
• Latest Microsoft Edge
• Latest Apple Safari

• Office suite software (Microsoft Office, OpenOffice, or LibreOffice)
• PDF reader program (Adobe Reader, FoxIt)
• Courses may require other software that is denoted in the above course outline.