Medical Billing & Coding 600 Hours/12 Months/Instructor Supported

Transcription

1 Medical Billing & Coding 600 Hours/12 Months/Instructor Supported Our Medical Billing & Coding program is essential for individuals wanting to start a new career in the medical profession. Both full length courses will enable students to have the skills necessary to sit for and be successful on the national exams for billing and coding. Medical Billing is listed as one of the fastest growing professions in allied health. The medical industry is experiencing a tremendous demand for individuals with knowledge of medical office operations, which includes diagnostic and procedural insurance forms processing. Our Medical Billing course will give you the skills you need to be competitive in the healthcare market place, as well as the credentials through certification to prove your qualifications. In this course, students will learn about managed health care, legal and regulatory issues, coding systems, reimbursement methods, coding for medical necessity, and common health insurance plans. The medical industry is experiencing a tremendous demand for individuals with knowledge of medical office operations, which includes diagnostic and procedural coding. Take your first step toward a successful career in medical coding with comprehensive coverage from one of the most trusted programs in the field! This Medical Coding course is practical and shows you exactly how to code using all of today's coding systems by providing an in-depth introduction to essential coding concepts. In addition to coverage of reimbursement, ICD-9-CM, CPT, HCPCS, and inpatient coding, this course offers complete coverage of the ICD-10-CM diagnosis coding system. No other course on the market so thoroughly prepares you for all coding systems in one course! This Program Includes 2 Courses: 1. Medical Billing 2. Medical Coding Prerequisite: Solid knowledge of Medical Terminology and Anatomy & Physiology. If you do not know Medical Terminology or Anatomy & Physiology you can take one or both of our additional courses. Medical Billing Our Medical Billing course will give you the skills you need to be competitive in the healthcare market place, as well as the credentials through certification to prove your qualifications. In this course, students will learn about managed health care, legal and regulatory issues, coding systems, reimbursement methods, coding for medical necessity, and common health insurance plans. Outline Medical Billing Module 1 Medical Terminology Pronunciation Spelling Word Roots Combining Vowels/Form Prefixes Suffixes Page 1 of 8

2 General Rules Word Building Abbreviations Procedural and Diagnostic Billing Codes Body Structure Organization of the Body Anatomical Position Body Planes Directional and Positional Terms Body Cavities Medical Billing Module 2 Foundations of Health Insurance Health Insurance Specialist Career Job Responsibilities Professionalism Introduction to Health Insurance Medical Documentation Electronic Health Record (EHR) Managed Health Care Managed Care Organizations Effects of Managed Care Processing of an Insurance Claim Managing New Patients Insurance Claim Life Cycle Credit and Collections Legal and Regulatory Issues Health Insurance Portability and Accountability Act (HIPAA) Medical Billing Module 3 Understanding Coding ICD-9-CM Coding Medical Necessity Outpatient Coding Guidelines Learning the ICD-9-CM Coding System CPT Coding CPT Sections, Subsections, Categories and Subcategories Coding Procedures and Services National Correct Coding Initiative HCPCS Level II Coding HCPCS Level II National Codes Determining Payer Responsibility Medical Billing Module 4 Reimbursement Methodologies CMS Reimbursement Methodologies CMS Payment System Ambulance Fee Schedule Page 2 of 8

3 Ambulatory Surgical Center Rates Clinical Laboratory Fee Schedule Home Health Prospective Payment System Hospital Payment System Inpatient Psychiatric & Rehabilitation Payment System Skilled Nursing Facility Payment System Revenue Cycle Management Coding for Medical Necessity Applying Coding Guidelines Coding and Billing Considerations Coding from Case Scenarios Medical Billing Module 5 Understanding Insurance Essential CMS-1500 Claim Instructions Insurance Billing Guidelines Optical Scanning Guidelines Entering Patient and Policyholder Names Recovery of Funds from Responsible Payers National Provider Identifier (NPI) Reporting Diagnoses: ICD-9-CM Codes Reporting Procedures and Services: HCPCS/CPT Codes Steps in Processing Claims Commercial Insurance Automobile, Disability and Liability Insurance Commercial Group Health Plan Coverage Blue Cross Blue Shield (BCBS) Plans Billing Notes & Claims Instructions BCBS Secondary Coverage Medical Billing Module 6 Medicare & Medicaid Medicare Eligibility & Enrollment Medicare Parts A, B, C, & D Employer and Union Health Plans Medigap Mandatory Claims Submission Advance Beneficiary Notice Medicare Summary Notice Medicare-Medicaid (Medi-Medi) Crossover Claims Roster Billing for Mass Vaccination Programs Medicaid Eligibility Medicaid Covered Services Payment for Medicaid Services Mother/Baby Claims SCHIP Claims Medical Billing Module 7 TRICARE & Workers Compensation Page 3 of 8

4 TRICARE Background & Administration CHAMPVA TRICARE Options TRICARE Programs TRICARE Supplemental Plans Billing Notes & Claims Instructions Federal Workers' Compensation Programs State Workers' Compensation Programs Eligibility for Workers' Compensation Coverage Workers' Compensation and Managed Care First Report of Injury Form Progress Reports Appeals and Adjudication Fraud and Abuse Medical Coding Medical Coding is listed as one of the fastest growing professions in allied health. The medical industry is experiencing a tremendous demand for individuals with knowledge of medical office operations, which includes diagnostic and procedural coding. Outline Medical Coding Module 1 Medical Terminology Pronunciation Spelling Word Roots Combining Vowels/Form Prefixes Suffixes General Rules Word Building Abbreviations Procedural and Diagnostic Billing Codes Body Structure Organization of the Body Anatomical Position Body Planes Directional and Positional Terms Advanced Medical Coding Module 2 Introduction to Coding A Career as a Medical Coder Types of Coding Page 4 of 8

5 ICD-9-CM V Codes and E Codes M Codes Categories, Subcategories, and Subclassifications Procedural Coding with ICD-9-CM Procedures in ICD-10-CM HCPCS Level II HCPCS II Hierarchy HCPCS II Medication Flow Chart Current Procedural Terminology (CPT) AMA/CPT Code Book Symbols & Unlisted Codes CPT Surgical Guidelines Radiology and Pathology Guidelines Category II and III Codes Advanced Medical Coding Module 3 Coding for Anesthesia, General Surgery and the Integumentary System AMA/CPT Evaluation and Management (E / M) Guidelines Criteria of Documentation E / M Selection Types of Anesthesia Anesthesia Coding General Surgery The Respiratory System The Cardiovascular System The Hemic and Lymphatic Systems The Digestive System The Urinary System The Nervous System The Ocular Adnexa and Auditory Systems E / M for Integumentary / Skin Surgical Guidelines for Integumentary Incision and Drainage Debridement Biopsy & Removal of Skin Tags Intralesional Injections and Tissue Expanders Graft Concepts and Tissue Transfer Repair and / or Reconstruction Advanced Medical Coding Module 4 Coding for Orthopedics, Cardiology, and OB/GYN Fractures Dislocations Arthropathy Vertebral Disorders Sprains and Strains Cardiac and Vascular Anatomy & Physiology Series of CPT Page 5 of 8

6 Intracardiac Electrophysiological Procedures Other Vascular Studies Noninvasive Vascular diagnostic Studies Series of CPT Radiology Using Modifiers Effectively Category II Codes Unique Aspects of Coding OB/GYN The Female Reproductive System Obstetrics and Gynecology (OB/GYN) Advanced Medical Coding Module 5 Coding for Radiology, Pathology, Laboratory & General Medicine Radiology & CPT Coding Diagnostic Radiology & Ultrasound Radiation Oncology & Nuclear Medicine CPT Pathology and Laboratory Evocative/Suppression Testing Hematology and Coagulation Transfusion Medicine Anatomic Pathology Surgical Pathology General Medicine Guidelines Immunization Administration Therapeutic Infusions & Injections Psychiatry & Psychiatric Therapeutic Care Dialysis Gastroenterology Ophthalmology Otorhinolaryngology Services Cardiology & Pulmonary Endocrinology Neurology and Neuromuscular Procedures Photodynamic Therapy & Dermatological Procedures Advanced Medical Coding Module 6 Billing, Collections, Filing the Claim Form, Payment, & Inpatient Coding Patient Registration Ambulatory Patient Groups Payment and Billing Processes The Collections Process Professional Courtesy The Health Insurance Claim Form Medicaid & Medicare Submitting a Claim for a Deceased Patient Health Maintenance Organizations (HMOS) CHAMPUS / TRICARE / CHAMPVA Workers Compensation Encounter Forms, Superbills, Fee Slips, or Charge Tickets Page 6 of 8

7 Step-By-Step Completion of a Paper CMS 1500 From Appealing the Claim Insurance Participation Agreements Denials, Rejections & Appeals Auditing & Fraud Risk Prevention Hospital Based ICD-9-CM Coding Unconfirmed Conditions Code Assignment Hospital Reimbursement Environment Medical Coding Module 7 CCA Test Preparation Part 1 Examination Study Strategies and Resources Coding Review Health Data Content, Requirements, and Standards Medical Science Classification Systems and Secondary Data Sources Medical Coding Module 8 CCA Test Preparation Part 2 ICD-9-CM Coding CPT Coding Medical Billing and Reimbursement Systems CCA Quiz CCA Mock Examination All Necessary Materials Included Certification: Upon successful completion of our Medical Billing course, students will be prepared for an entry-level position doing medical billing in a medical office setting and will be prepared to sit for the NHA national certification exam to become a Certified Billing and Coding Specialist (CBCS). System Requirements: Internet Access Broadband or high-speed internet access is strongly recommended. Broadband includes DSL, cable, and wireless connections. Dial-Up internet connections will result in a diminished online experience. Moodle pages may load slowly and viewing large audio and video files may not be possible. Hardware Virtually all Windows-Mac-Linux hardware configurations and processors are acceptable. 1 GB RAM recommended Software Operating Systems o Windows XP or Vista and Mac OS X 10 and higher, most Linux distributions Page 7 of 8

8 Web Browsers o Mozilla Firefox 2 and 3 (previous versions will work also) o Internet Explorer 6, 7 and 8 o Safari is not currently recommended as it cannot display certain Moodle editing menus for both students and instructors Media Plug-ins (These may be required depending on your course media-click on the links below to download the latest versions) Adobe Flash Player Adobe Acrobat Reader Apple Quicktime Windows Media Player Real Player PowerPoint Viewer (use this if you don't have PowerPoint) **Outlines are subject to change, as courses and materials are updated.** Page 8 of 8