Medical Billing and Coding - Certification Program

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 Law and Liability
• Insurance and Contract Law
• Medical Ethics and Etiquette
• CMS-1500

Medical Billing & Coding Module 2
The Patient and Billing Process and Managed Care

• Patient Expectations
• HIPAA Requirements
• Billing Policies and Practices
• Collection Techniques
• Reimbursements
• Types of Health Insurance
• How Fees are Determined
• What is Managed Care?
• Types of Managed Care Organizations

Medical Billing & Coding Module 3
Medicare and Medicaid

• Medicare Combination Coverages
• Medicare Audits and Appeals
• Medicare Billing Fraud
• Medicaid and Healthcare Reform
• Medicaid Premiums and Cost-Sharing
• Emergency Medical Treatment and Labor Act
• Processing Medicaid Claims
• Medicaid and Third-Party Liability
• Workers’ Compensation

Medical Billing & Coding Module 4
Claims and Diagnostic Coding

• Electronic Claims
• Health Insurance Portability and Accountability Act
• HIPAA Version 5010 Transactions and Code Standards
• Universal Claim Form (CMS-1500)
• Process of Classifying Diseases
• Coding Steps for the Alphabetic Index
• Evaluation and Management Coding
• Importance of Documentation
• HCPCS Coding

Medical Billing & Coding Module 5
Claims Management and Computers

• The Claims Management Process
• Keys to Successful Claims
• Optimizing the Billing and Claims Process
• Appeals
• Impact of Computers on Health Insurance
• Role of HIPAA in Electronic Transmissions
• Electronic Claims Process
• Electronic Health Record

Medical Billing & Coding Module 6
Reimbursement and Hospital Billing

• Understanding Reimbursement Systems
• Medicare and Reimbursement
• Systems for Determining Reimbursement
• Reimbursement Systems
• Prospective Payment Systems
• Computerized Patient Accounting Systems
• HIPAA and Practice Management Software