Medical Billing

Medical Billing

Medical Billing

2 Sessions –

200 Hours of Interactive Training

Our Medical Billing course teaches students the procedural and legal implications of the medical billing process. In addition to developing the professional skills necessary for accurate medical billing, this course will help the student prepare to sit for the Certified Medical Claims Professional (CMCP) exam that is sponsored by the American Career Certification Board. Our Medical Billing course is the Authorized Curriculum for the Certified Medical Claims Professional (CMCP) exam. The companion CertBlaster for this class contains in excess of 100 practice questions for the CMCP exam. With more than 200 hours of interactive online study, this course requires no other prerequisite than a GED level educational background and either a familiarity with medical terminology, or the successful completion of our Medical Terminology course.

Benefits

Learn the procedures to achieve accurate billing for medical services.

Develop the skills and knowledge necessary to take the national certification exam.

Flexible, online course delivery allows periodic retraining for experienced professionals.

About The Author

This training program was produced by LearnKey and content partner DTI. DTI maintains relationships with an impressive list of publishers with content covering a wide variety of subject matter areas. DTI also has relationships with a host of subject matter experts who are distinguished authors, trainers, consultants and educators.

Session 1

Section A: Who Pays and Who Benefits?
· Objective
· Introduction: Understanding Basic Terms
· Understanding Various Billing Forms
· Types
· Birthday Rule
· Some More Terms
· Medical Record and SOAP
· Codes and Their Classification
· Medicare Claims
· Co-payments
· Deductible
· Electronic Claims, EOB
· CMS and HMO
· Identification Numbers
· Medicaid and Medicare
· Par Provider
· PPO, PCP
· Payers: Primary and Secondary
· Superbill
· Some More Terms
· Workmen’s Compensation
· Exercise – Build a Sentence
· Exercise – Crosswords

Section B: Provider Structure and Protocols
· Objective
· Introduction: Function of Staff
· Staff and Responsibilities
· Office Manager
· Receptionist
· Billing Clerk
· Health Insurance Specialist
· Coding
· Staffing Levels
· Best Practice Elements
· Payment Policies and Fees
· Payments and Adjustments
· Co-payments
· Insurers
· Adjustments
· Charge Capture
· Compliance Plan
· Managed Care
· Controls Related to Payments
· The Patient

Section C: Hospital Billing
· Objective
· Outpatient Services
· Inpatient Services
· Combinations
· Billing Functions
· Exercise – Build a Sentence

Section D: An Introduction: Family Relationships
· Objective
· Family Relationships
· Exercise – Fill in the Blanks

Section E: Billing the Encounter
· Objective
· Introduction
· Superbill
· Data Entry
· Prebilling Protocols

· Processing
· Insurance Forms
· Types of Processing
· Sample Insurance Form
· How To Fill the Form
· Hospital Visit
· How To Fill the Form
· How To Fill the Form Review
· Paper and Electronic Claim
· Factoids
· Paper Claims
· Electronic Claims
· Payments, Adjustments
· General Information
· Notes About Payments
· Analyzing Information
· An Example
· Important Points
· Appeal Process
· What Is It?
· Statements
· About Statements
· Points to Remember
· Types of Statements
· From Letter
· Example
· More About Statements
· Example
· Computers and Statements
· Exercise – Fill in the Blanks

Section F: Practice Economics
· Objective
· Introduction
· Reports
· Types Accounts Receivable
· Summary
· Aging Summary
· Overcome the Delinquency in Payments
· Types
· Miscellaneous Reports
· Exercise – Fill in the Blanks

Section G: Collections
· Objective
· Introduction
· Meeting Agenda
· A Sample
· What Was the Outcome of the Meeting?

Section H: Medical Coding Systems
· Objective
· Introduction: Coding
· CPT Codes
· Need for Coding
· Introduction
· A Description
· Processing of CPT Codes
· Need for CPT Codes
· CPT Coding Levels
· Coding Guidelines
· Modifiers
· Code Book Section
· Symbols
· Evaluation and Management Codes
· Evaluation and Management Descriptors
· Types of Services
· Hospital Inpatient Services
· Subsequent Hospital Care

· Hospital Discharge Services
· Consultations
· Other Codes
· Procedure Codes
· An Intro to ICD
· Coding Summary
· An Overview
· Coding Exercises
· Example
· Coding Different Charts
· Examples of ICD Codes
· Coding Software
· Reports 1 – 15

Section I: Fee Profiles
· Objective
· Introduction
· Fee Profiles
· Background – A Transition Phase
· Present Scenario
· Advantages of CPT System
· Points for Consideration
· Role of Insurance Companies
· Fee Profiles

Section J: Overview of Medicaid-Medicare

Session 2

Section A: Health Insurance Specialist
· Objective
· Health Insurance Specialist
· Basic Skill Requirements
· Medical Terminology
· Coding ICD-9-CM
· Coding ICD-10-CM
· Classification of Diseases
· Codes and Manuals of ICD-9 and 10
· CPT: Current Procedural Terminology
· HCPCS: Coding System Levels
· Exercise – Crossword
· Exercise – Build a Sentence

Section B: Terms
· Objective
· Terms Commonly Used
· Evolution of Reimbursement
· Continued Legislation
· Legislation to Standardize Claims
· Health Insurance: Disability
· Different Types of Insurance
· Legislation to Control Rising Costs: Medicare/Medicaid
· Different Payment System
· Medicare’s Fee Schedule
· Does Medicare Pay Providers Differently?
· Exercise – Crossword
· Exercise – Build a Sentence

Section C: Health Care Organization Plans
· Objective
· Commonly Used Terms
· MCO

Medical Billing continued

· Different Managed Care Models
· Plan Accreditation
· Practice Ramifications
· Exercise – Build a Sentence

Section D: Insurance Claims
· Objective
· Overview: Actual Insurance Processing Steps
· Insurance Process
· Patient Registration
· Primary vs. Secondary Insurance
· Birthday Rule
· Consent Forms
· Coding and Data Entry
· Co-payments
· Insurance Form Production
· Presubmission Checklist
· Sample Forms
· HCFA-1450 (UB-92) Instructions
· Sample Forms
· Form-Filling
· Insurance Claims
· Factoids
· Clearinghouses
· Some Tips and Notes

Section E: Payer Processing
· Objective
· Processing Claims
· Initial Process
· Explanation of Benefits
· Recordkeeping Rules
· Processing Errors/Denials
· Delinquent Insurance Payment
· Insurance Regulation
· Exercise – Crossword
· Build a Sentence

Section F: Law, Rules and Regulations
· Objective
· Federal and State
· Commonly Used Terminology
· Patient Information Management
· Regarding Enquires
· Regarding the Internet
· ERISA
· Other Acts
· HIPAA
· Fraud and Abuse
· Penalties
· Correct Coding Initiative
· Overpayments Liability
· Exercise – Crossword
· Exercise – Build a Sentence

Section G: Private Insurers
· Objective
· Private Insurers
· Blue Cross and Blue Shield
· Preferred Providers
· Blue Cross and Blue Shield Plans
· Managed Care
· Federal Employee Program
· Billing Rules
· Exercise – Crossword
· Exercise – Build a Sentence

Section H: Medicare
· Objective
· About Medicare
· Medicare Eligibility
· Supplementary Program

· QMBP and SLMB
· Disability
· Verifying Coverage
· Coverage
· Acute Care Hospitalization
· Skilled Nursing Facility
· Hospice Care
· Other Coverage
· Standard Coverage
· Preventive Coverage
· Deductibles and Co-insurance
· Participation vs. Non-Participation
· Assignment Issues
· Disclosure
· Claims Submission
· State Laws Governing Medicare
· Private Contracts
· Experimental and Investigational Procedure
· Exercise – Crossword
· Exercise- Build a Sentence

Section I: Medicaid
· Objective
· About Medicaid
· Groups with Matching Federal Funds
· Mandatory
· Optional
· Others
· SCHIP: State Children’s Health Insurance Program
· Provider Confirmation of Eligibility
· Covered Service
· Basic Services
· Other Optional Services
· EPSDT
· Pre-authorized Services
· Medicare/Medicaid Crossovers
· Payment for Services
· More Information
· Absolutes
· Utilization of Review
· Billing Information
· About Filing Claims
· Note
· Mother/Child Claims
· Exercise – Crossword
· Exercise – Build a Sentence

Section J: Tricare
· Objective
· What Is Tricare?
· Tricare
· Service Centers
· Case Management
· Options
· Extra
· Standard
· For Life
· Dental and Supplemental Plans
· CHAMPVA
· Medicare Impact
· Co-Liability and Billing Protocol
· Payment
· Sample Forms
· Exercise – Crossword
· Exercise – Build a Sentence

Section K: Workers’ Compensation
· Objective
· Commonly Used Words
· Workers' Compensation
· Various Programs
· State Programs
· Eligibility
· Disability
· Miscellaneous
· Provider Rules
· Progress Reports and Payments
· Confidentiality and Limitations
· Sample Instructions
· Billing Protocols
· Appeals
· Claim Forms
· Congratulations