Medical Billing

Medical Billing Module 1
Basics of Insurance Billing and Compliance

• Insurance Billing Specialist
• Insurance Claims, Coding, & Billing Background
• Medical Etiquette
• Medical Ethics
• Health Insurance Portability and Accountability Act (HIPAA)
• Fraud and Abuse Laws
• Compliance Programs
• Health Care Reform
• Insurance Policies

Medical Billing Module 2
Basics of Health Insurance

• History of Health Insurance in the United States
• Health Care Reform
• Types of Health Insurance Coverages
• Private Health Insurance
• Managed Care Systems
• Financial Management
• Medicare
• Policies and Regulations
• Medicare Reimbursement
• Claim Submission

Medical Billing Module 3
State Programs and Veterans’ Health Care

• Medicaid Programs
• Medicaid Eligibility
• Medicaid Benefits
• Medicaid Managed Care
• TRICARE
• History of Tricare
• Health Plans
• Veterans Health Administration Program

Medical Billing Module 4
Workers’ Compensation and Disability Programs

• Workers’ Compensation Laws and Insurance
• Types of State Compensation Benefits
• Fraud and Abuse
• Legal Situations
• Reporting Requirements
• Disability Claims
• Disability Income Insurance
• Federal Disability Programs
• State Disability Insurance
• Voluntary Disability Insurance

Medical Billing Module 5
Documentation and Coding for Professional Services

• Documentation Process
• Electronic Health Records
• Health Record Documentation
• Review and Audit of Health Records
• Diagnostic Coding
• Official Guidelines for ICD-10-CM
• Procedural Coding
• Current Procedural Terminology Content and Format
• Code Modifiers

Medical Billing Module 6
Claims Submission in the Medical Office

• The Paper Claim CMS-1500
• Types of Submitted Claims
• Health Insurance Claim Form (CMS-1500)
• Claim Completion Guidelines
• Electronic Claims
• Clearinghouses
• Claim Attachment Standards
• Practice Management System
• Computer Claims Systems

Medical Billing Module 7
The Claim Follow-Up and Payment Process

• Revenue Cycle Management
• Claim Policy Guidelines
• Explanation of Benefits
• Claim Management Techniques
• Rebilling
• Review and Appeal Process
• Filing an Appeal
• Collection Strategies
• Accounts Receivable

Medical Billing Module 8
Healthcare Facility Billing

• Ambulatory Surgery Centers
• Payment Systems
• Payment Rates
• Revenue Cycle Management
• Medical Records for Reimbursement
• Hospital Outpatient and Inpatient Billing
• Employment Opportunities
• Self-Employment

**Outlines are subject to change, as courses and materials are updated.**