Medical Billing and Coding
(MED-BILL.AE1) / ISBN : 978-1-64459-474-2
About This Course
This comprehensive course provides a solid foundation in medical billing and coding, essential skills for healthcare administration professionals. Students will learn to navigate complex medical terminology, understand various coding systems including ICD-10 and CPT, and master the intricacies of insurance claims processing. The curriculum covers key topics such as regulatory compliance, electronic health records, and reimbursement methodologies. Through hands-on exercises and real-world case studies, participants will develop the practical skills needed to accurately code medical procedures, diagnoses, and treatments. By the end of the course, students will be well-prepared to pursue certification and embark on a rewarding career in this in-demand field, playing a crucial role in ensuring efficient healthcare operations and appropriate reimbursement for medical services.
Skills You’ll Get
Get the support you need. Enroll in our Instructor-Led Course.
Interactive Lessons
22+ Interactive Lessons | 102+ Flashcards | 102+ Glossary of terms
Introduction
- About This Course
- Icons Used in This Course
- Where to Go from Here
Dipping Your Toes into Medical Billing and Coding
- Coding versus Billing: They Really Are Two Jobs
- Following a Day in the Life of a Claim
- Keeping Abreast of What Every Biller/Coder Needs to Know
- Deciding Which Job Is Right for You
- Prepping for Your Career: Training Programs and Certifications
- Planning for the Future
Exploring the Billing and Coding Professions
- Looking at the Medical Coding Job
- Breaking Down the Medical Biller’s Job
- In Tandem: Working Together or Doing Both Jobs Yourself?
Weighing Your Employment Options
- Choosing Your Environment: Doctor’s Office, Hospital, and Others
- Remote Access: Setting up Off-Site
- Reviewing Other Work Options: Freelancing, Temping, and More
- Heeding a Word of Advice for New Coders
Compliance: Understanding the Rules
- You Rule! Meeting the Rule Makers
- Complying with HIPAA
- Unbundling the Compliance Bundle
- Getting the Most out of the Dreaded Audit
Not-So-Strange Bedfellows: Medical Terminology and Medical Necessity
- Brushing Up on Basic Anatomy
- Say What? Deciphering Medical Terminology
- Understanding Medical Necessity
- Scrubbing In: Proving Medical Necessity for Surgical Procedures
- Connecting with the World of Evaluation and Management Codes
Getting to Know the Payers
- Wading through Commercial Insurance Payers
- Medicare: Meeting the Chief Government Payer
- Working with Other Government Payers
Your Basic Certification Options, Courtesy of the AAPC and AHIMA
- Introducing the Two Main Credentialing Organizations: AAPC and AHIMA
- Looking at the Basic Certifications
- Choosing the Certification That’s Right for You
- Examining the Exams: A Quick Review of the Main Tests
The Path to Certification: Finding a Study Program
- The Big Picture: Thinking about Your Degree and Career Objectives
- Considering the Time Commitment
- First Things First: Squaring Away Your Prerequisites
- Picking a Program of Study
- Caveat Emptor: Watching Out for Diploma Mills
Signing Up and Preparing for the Certification Exam
- Establishing a Study Routine and Strategy
- Focusing on the Right Topics
- Preparing Yourself for Test Day
- Signing Up for and Taking the Big Test
Adding Street Cred: Specialty Certifications and Continuing Ed
- Introducing Specialty Certification Options
- Building on Your Cred with Continuing Education
Processing a Run-of-the-Mill Claim: An Overview
- Dreaming of the Perfect Billing Scenario
- Delving into the Details: Contract Specifics
- Covering Your Bases: Referrals and Preauthorization
- Tracking Your Claim from Submission to Payment
- Fighting for Proper Payment: Filing an Appeal with the Payer
Homing In on How to Prepare an Error-Free Claim
- Assigning CPT Codes
- Applying Modifiers Correctly
- Looking for Money Left on the Table
- Checking and Double-Checking Your Documentation
From Clearinghouse to Accounts Receivable to Money in the Pocket
- Spending Time in the Clearinghouse
- Facing Factors Affecting Reimbursement Amounts
- Payment or Denial: Being in the Hands of the Payer
- Breaking Down the Remittance Advice
Handling Disputes and Appeals
- Dealing with Disputes Involving Contract and Non-Contracted Payers
- Knowing When to File an Appeal: General Guidelines
- The Art of the Appeal: Understanding the Basics before You Begin
- Going through an Appeal, Step by Step
- Appealing Medicare Processing
- Appealing a Workers’ Comp Claim
Keeping Up with the Rest of the World
- WHO’s on First: Providing Data to the World Health Organization
- Charting Your Course with ICD
- Moving beyond ICD-10
Dealing with Commercial Insurance Claims
- Meeting Commercial Insurance
- Cashing In with Commercial Payers
- Knowing What’s What: Verifying the Patient’s Plan and Coverage
Caring about Medicare and Medicaid
- Brushing Up on Medicare Basics
- Working with Medicare Claims
- Deciding What Gets Paid
- Working with Medicare Contractors
- Doing Business with Medicare Part C Plans
- Verifying Coverage and Plan Requirements
Coding Ethics: Being an Advocate for Your Employer
- Playing the Part of the Professional Medical Biller/Coder
- Protecting Yourself and Your Integrity
- Getting the Most Bang for Your Client’s Buck — Honestly
Ten Common Billing and Coding Mistakes and How to Avoid Them
- Being Dishonest
- Shifting the Blame
- Billing More than Is Documented
- Unbundling Incorrectly
- Ignoring an Error
- Mishandling an Overpayment
- Failing to Protect Patients from Out-of-Network Penalties
- Failing to Verify Prior Authorization
- Breaking Patient Confidentiality
- Following the Lead of an Unscrupulous Manager
Ten Acronyms to Burn into Your Brain
- ACA: Patient Protection and Affordable Care Act
- ACO: Accountable Care Organization
- CDI: Clinical Documentation Improvement
- CMS: Centers for Medicare & Medicaid Services
- EHR: Electronic Health Record
- EOB: Explanation of Benefits
- HIPAA: Health Insurance Portability and Accountability Act
- INN: In-Network
- NCCI: National Correct Coding Initiative
- OON: Out-of-Network
Ten (Plus One) Tips from Billing and Coding Pros
- Insist on Proper Documentation
- Verify Patient Benefits
- Get Vital Patient Info at Check-In
- Review the Documentation ASAP
- Set Up a System to Ensure Accuracy
- Play Nice with Others
- Follow Up on Accounts Receivable Daily
- Be a Bulldog on the Phone
- Know Your Payer Contracts by Heart
- Create a File System That Lets You Find What You Need
- Make Payers Show You the Money!
Dipping Your Toes into Medical Billing and Coding
- Gaining Knowledge about Federal and State Regulations
- Knowing about Billing and Coding Job
Exploring the Billing and Coding Professions
- Learning about Super-Bill
- Looking at the Medical Coding Job
- Verifying Documetation
- Choosing Medical Coding as a Profession
- Understanding the CMS-1500 Form
- Understanding Payers and Organizations
- Knowing about the HCFA/CMS-1500 Form
Compliance: Understanding the Rules
- Understanding HHS agency
- Working with OIG
- Understanding HIPAA Titles
- Working with Key Provisions of HIPAA
- Understanding Compliance Bundle
- Learning about Laparoscopic Procedure
Not-So-Strange Bedfellows: Medical Terminology and Medical Necessity
- Knowing about Medical Terminologies
- Learning about Arthroscopic Surgery
- Learning about Hospital Visit Code
- Examining Patient Status
Getting to Know the Payers
- Understanding Commercial Plans
- Learning about TPAs
- Identifying the Carriers
- Working with Medicare Type
- Understanding Payouts
- Knowing about Tricare Program
Your Basic Certification Options, Courtesy of the AAPC and AHIMA
- Getting to Know about the AAPC Certifications
- Understanding AHIMA Certifications
The Path to Certification: Finding a Study Program
- Learning about Online Programs
- Learning about Community College
Signing Up and Preparing for the Certification Exam
- Learning about Respiratory System
- Learning about Endocrine System
- Learning about Muscular System
- Understanding Digestive System
Adding Street Cred: Specialty Certifications and Continuing Ed
- Understanding AAPC Certifications
Processing a Run-of-the-Mill Claim: An Overview
- Learning about Contracts
- Knowing about Carve-Outs
- Knowing about Prior Authorization
Homing In on How to Prepare an Error-Free Claim
- Assigning CPT Codes
- Applying Modifiers Correctly
- Understanding Tricare
From Clearinghouse to Accounts Receivable to Money in the Pocket
- Understanding Insurance Claim
Handling Disputes and Appeals
- Appealing Medicare Processing
Keeping Up with the Rest of the World
- Working with the 5010 Platform
Dealing with Commercial Insurance Claims
- Cashing In with Commercial Payers
Caring about Medicare and Medicaid
- Knowing about Advance Beneficiary Notice
Coding Ethics: Being an Advocate for Your Employer
- Avoiding Accusations of Fraudulent Billing
Ten Acronyms to Burn into Your Brain
- Learning about Medical Offices
- Understanding HIPPA
- Understanding NCCI