- Description
- Objectives
- Outline
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Our Medical Billing & Coding Professional program prepares individuals for a rewarding career in the medical billing field, while also teaching about the anatomy and physiology of the body.
Medical Billing
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. This Medical Billing course covers all the plans that are most commonly encountered in clinics and physicians' offices. An emphasis on the role of the medical insurance specialist prepares you for success in the workplace, including areas such as diagnostic coding, procedural coding, Medicare, HIPAA and bill collection strategies. Our Medical Billing course will give you the skills you need to be competitive in the healthcare marketplace.
Prerequisite(s): None
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. 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, 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!
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.
** Course Subject to Change.
Medical Billing
After completing this course, you should be able to:
- Identify the core elements of health insurance
- List features of the different coding systems and their documentation
- Define the features of processing claim forms both electronic and paper
- Recall the basics of fee and insurance collection
- Recognize the features of various health care payer types
Medical Coding
After completing this course, you should be able to:
- Identify the core elements of the ICD-10-CM coding system
- Recognize the conventions and guidelines of the ICD-10-CM coding system
- List the conventions and guidelines of the HCPCS coding system
- Define the fundamental uses and guidelines of the CPT coding system
- Recall the use of modifiers and evaluation and management services (E/M)
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.**
Medical Coding
Medical Coding Module 1
Overview of ICD-10-CM
- Reimbursement, HIPAA and Compliance
- Basic Structure of the Medicare Program
- Improvements to the ICD-10-CM
- ICD-10-CM Format
- Mapping
- Outpatient Coding and Reporting Guidelines
- Unconfirmed Diagnosis
- Z Codes
- Chronic Diseases
- Therapeutic Services
Medical Coding Module 2
Using ICD-10-CM
- Accurate Coding
- Alphabetic Index and Tabular List
- Level of Specificity
- Integral Conditions
- Multiple Coding
- Chapter Specific Guidelines Chapters 1-10
- Endocrine, Nutritional and Metabolic Diseases
- Diseases of the Nervous System
- Diseases of the Circulatory System
- Diseases of the Respiratory System
Medical Coding Module 3
Chapter-Specific Guidelines
- Diseases of the Digestive System
- Diseases of the Skin and Subcutaneous Tissue
- Diseases of the Musculoskeletal System and Connective Tissue
- Pregnancy, Childbirth and Puerperium
- Congenital Malformations, Deformations and Chromosomal Abnormalities
- Symptoms, Signs and Abnormal Clinical and Laboratory Findings
- Injury and Poisoning
Medical Coding Module 4
CPT, HCPCS and Modifiers
- The Purpose of the CPT Manual
- Updating the CPT Manual
- CPT Manual Format
- Level II National Codes (HCPCS)
- History of National Level Codes
- Updating the HCPCS Manual
- National Physician Fee Schedule
- CPT Modifiers
Medical Coding Module 5
E/M Services and Anesthesia
- Contents of the E/M Section
- Three Factors of E/M Codes
- Various Levels of E/M Service
- An E/M Code Example
- Using the E/M Codes
- Documentation Guidelines
- Types of Anesthesia
- Anesthesia Section Format
- Formula for Anesthesia Payment
- Concurrent Modifiers
Medical Coding Module 6
Surgery Guidelines and Integumentary System
- Surgery Section
- Notes and Guidelines
- Special Reports
- Separate Procedure
- Surgical Package
- Skin, Subcutaneous and Accessory Structures
- Burns
- Destruction
- Breast Procedures
Medical Coding Module 7
Musculoskeletal and Respiratory Systems
- Fractures and Dislocations
- Application of Casts and Strapping
- Endoscopy
- Arthroscopy
- Accessory Sinuses
- Larynx
- Trachea
- Bronchi Lungs and Pleura
Medical Coding Module 8
Cardiovascular, Hemic, Lymphatic and Digestive Systems
- Cardiovascular Coding in the Surgery Section
- Cardiovascular Coding in the Medicine Section
- Cardiovascular Coding in the Radiology Section
- Hemic and Lymphatic Systems
- Mediastinum and Diaphragm
- Lips
- Vestibule of Mouth
- Salivary Glands and Ducts
- Pharynx, Adenoids and Tonsils
- Intestines
Medical Coding Module 9
Urinary, Reproductive and Genital Systems
- Urinary System
- Male Genital System
- Intersex Surgery
- Reproductive System Procedures
- Male and Female Genital Systems
- Maternity Care and Delivery
Medical Coding Module 10
Endocrine System, Eye, Ocular Adnexa and Radiology
- Nervous System
- Auditory System
- Operating Microscope
- Radiology Terminology
- Diagnostic Radiology
- Breast Mammography
- Diagnostic Ultrasound
- Radiation Oncology
Medical Coding Module 11
Pathology/Laboratory, Medicine and Inpatient Coding
- Organ or Disease Oriented Panels
- Therapeutic Drug Assays
- Urinalysis, Molecular Pathology and Chemistry
- Immunizations
- Gastroenterology
- Allergy and Clinical Immunology
- Medical Nutrition Therapy
- Medication Therapy Management Services
- Differences between Inpatient and Outpatient Coding
- Present on Admission (POA)
**Outlines are subject to change, as courses and materials are updated.**
Ed4Career is committed to being both environmentally conscious and making it easier for you to study! We’re making your education mobile! All of our textbooks are now provided as eTextbooks*. You can access them on your laptop, tablet, or mobile device and can study anytime, anywhere.
The move away from physical books to eTextbooks means you get the latest, most up-to-date version available. This also makes your training more accessible, so you can study anywhere you have your phone or tablet. The best part is that all materials are included in your training cost so there are NO extra fees for books!**
*A few courses still have physical materials.
Medical Billing
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 Med-Certification exam to become a Certified Medical Billing Specialist (CBS) or the AAPC certification exam to become a Certified Professional Biller (CPB).Medical Coding
Upon successful completion of our Medical Coding course, students will be prepared for an entry-level position doing medical coding in a medical office setting and will be prepared to sit for the AHIMA national certification exam to become a Certified Coding Associate (CCA).** Certification exams are not included in the cost of the course.**
Internet Connection
- Broadband or High-Speed - DSL, Cable, and Wireless Connections
*Dial-Up internet connections will result in a diminished online experience. Classroom pages may load slowly and viewing large audio and video files may not be possible.
Hardware Requirements
- Processor - 2GHz Processor or Higher
- Memory - 1 GB RAM Minimum Recommended
PC Software Requirements
- Operating Systems - Windows 7 or higher
- Microsoft Office 2013 or higher. Also, you could use a general Word Processing application to save and open Microsoft Office formats (.doc, .docx, .xls, .xlsx, .ppt, .pptx)
- Internet Browsers - Google Chrome is highly recommended
- Cookies MUST be enabled
- Pop-ups MUST be allowed (Pop-up Blocker disabled)
- The Kindle Reader App or VitalSource Bookshelf App are needed for many of our courses (No special equipment needed. This can be downloaded for FREE onto your computer.)
- PowerPoint Viewer (if you do not have PowerPoint)
- Adobe PDF Reader
- QuickTime, Windows Media Player &/or Real Player
MAC Software Requirements
- Operating Systems - Mac OS x 10 or higher with Windows
- Mac office programs or a Word Processing application to save and open Microsoft Office formats (.doc, .docx, .xls, .xlsx, .ppt, .pptx)
- Internet Browsers- Google Chrome is highly recommended
- Cookies MUST be enabled
- Pop-ups MUST be allowed (Pop-up Blocker disabled)
- The Kindle Reader App or VitalSource Bookshelf App are needed for many of our courses (No special equipment needed. This can be downloaded for FREE onto your computer.)
- PowerPoint Viewer (if you do not have PowerPoint)
- Adobe PDF Reader
- Apple QuickTime Media Player