Medical Billing Course Syllabus Pre-requisites: Knowledge of medical terminology and anatomy recommended.
Clock Hours: 60
Course Length: 4-months
Class Hours: Days/Times Per Week: 8 hours/2x’s per month/Saturday Class
Certificate of Completion Issued: Yes
Course Description: This course introduces the student to health insurance and reimbursement. In this course, the student will become familiar with the health insurance industry, legal and regulatory issues, and differences in reimbursement methodologies. The student will learn principles of medical billing related to proper claim form preparation, submission and payment processing, and the follow up process. This course is recommended for anyone who is preparing for a career in a medical billing department at a physician's office, clinic, or similar positions.
Course Objectives: • Review an introduction to healthcare from a medical billing perspective. • List a variety of health insurance models and how they affect medical entities. • Understand the legal regulatory considerations involved in health care reimbursement and collections. • Explain the process of a physician-based insurance claim including obtaining patient data, claim form completion, insurance carrier processing and payment received. • Demonstrate the ability to use the three major coding manuals, CPT®, ICD-10-CM, and HCPCS Level II, and apply medical necessity standards. • Explain the follow up process for A/R in a physician’s office, including the top denials by insurance carrier along with their appeals process.
Course Content: • Introduction to Healthcare • Health Insurance Models • Patient Registration Process/Data Capture • Introduction to ICD-10-CM Coding • Introduction to CPT® Coding • Introduction to HCPCS Level II Coding • Medical Necessity • Claim Forms (CMS-1500 and UB-04) • Billing • A/R and Collection Concepts • Government Carriers (Medicare, Medicaid, and TRICARE) • Blue Cross/Blue Shield • Commercial Insurance Carriers • Workers’ Compensation • Final Exam
Methods of Evaluation: The instructional methods used include reading assignments, practice exercises, practical applications, interactive video/audio lectures, chapter review tests, and final exam. To receive a certificate of completion, students must successfully complete the course within the allotted time frame of 4 months.
Successful course completion includes: • An attempt of all required assignments • A passing score of 70% or higher on all chapter review exams • A passing score of 70% or higher on final exam • An overall final course score of 70% or higher
No reduced hours in the course or tuition discount for previous education or training will be granted.
Included Reading Material: Medical Billing Training Handouts
Required Textbooks (Included): 1. CPT® Professional Edition code book (2018 year), AMA publisher 2. ICD-10-CM code book (2018 year), any publisher 3. HCPCS Level II Professional code book (2018 year), any publisher
Recommended Textbooks/Supplies (Not Included): 1. Medical dictionary, any publisher.