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.**