COURSE NAME:

Billing & Coding
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Billing & Coding Specialist Certificate Program

Duration: 320 class room hours and 160 externship hours

Prerequisites: 18 years of age, High school diploma or GED, basic computer knowledge, word processing and typing experience

Goals and Purpose:

The Medical Insurance Billing and Coding curriculum prepares the student for ENTRY-LEVEL employment to process insurance claims that have become the life support of the medical office. There are a dozen roles that the student can fulfill in this growing area that includes patient and administration contact, working with computers, and accounting tasks. Specific duties center on: data collection from patients, hospitals, laboratories and physicians; diagnostic and procedure coding; timely generation of claims to maximize cash flow for the medical practice; keeping up to date on insurance plans, rules and regulations; bookkeeping transactions and follow-up on claims.

In this context, the student acquires the basic medical terminology, anatomy and physiology, procedural and diagnostic coding, types of medical insurance programs, insurance claims completion and submission, payment and follow-up procedures, relevant office skills and the role of computers in the medical office.

This course will offer student an optional opportunity to become nationally certified by the NHA, (National Healthcare Association).

Course Objectives

Upon completion of the course, the student should be able to:
  1. Discuss an insurance company claim process.
  2. Discuss the process for obtaining authorization for additional treatment by a healthcare specialist.
  3. Discuss the authorization process for a patient requesting an initial appointment with a health care specialist.
  4. Discuss the difference between the terms "primary diagnosis" and "principal diagnosis".
  5. Identify and properly use special terms, marks, abbreviations, and symbols used in ICD-9-CM coding system
  6. Explain the format of the CPT system.
  7. Discuss the qualifications for a "preventative medicine visit".
  8. Define the following terms, phrase and abbreviations:
    1. Medical necessity
    2. Subjective, Objective Assessments
    3. Plan
    4. Operative report
    5. OP notes
  9. Code diagnoses and procedures from source documents to complete insurance information on the CMS-1500 claim form. (Formerly HCFA-1500)
  10. State the four processing steps that must occur before a completed form can be mailed to the insurance company Explain function of National Blue Cross and Blue Shield Association.
  11. List six categories of persons eligible for Medicare coverage
  12. List and define seven types of insurance programs that are primary to Medicare.
  13. State the deadline for filing Medicare claims.
  14. List Medicaid federal guidelines List services covered under the federal portion of Medicaid assistance
  15. Explain how to verify a patient's Medicaid eligibility.
  16. List TRICARE eligibility categories; List six services that are not covered by TRICARE.
  17. Demonstrate understanding of HIPAA Compliance, PHI, and Confidentiality
  18. List and define the levels of TRICARE coverage.
  19. List the categories of workers covered by the federal compensation program.
  20. List and describe types of workers compensation available at state level. Describe the correct billing procedures for workers compensation cases.
  21. Describe how to set up a filing system for completed claim forms

Instructional Units:

  1. Introduction to Health Insurance
  2. Medical Laws and Ethics
  3. Anatomy, Physiology and Terminology for the Certified Billing & Coding Specialist
  4. Medical Office Skills (General)
  5. Insurance Claims Process
  6. ICD-9-CM Coding
  7. CPT Coding
  8. Medical Documentation
  9. Filing Commercial Claims
  10. Managed Care
  11. Blue Cross and Blue Shield Plans
  12. Medicare
  13. Medicaid and State Funded Programs
  14. TRICARE
  15. Workers Compensation
  16. HIPPA Compliance
  17. Tracing Delinquent claims & Insurance Problem
  18. Solving
  19. Collections
  20. Computerized Billing
  21. Career Development

Instructional Strategies:

  1. 1 on 1 Instruction
  2. Small Group Discussions
  3. Handouts
  4. Lecture
  5. Multimedia
  6. Individual Study
  7. Billing Software
  8. Textbook and Workbook

Evaluation:

  1. Class discussion & participation
  2. Skills demonstration
  3. Workbook activities
  4. Competency-based tests
  5. Performance Evaluation Checklists
  6. Self-Study Assignments
  7. Final Comprehensive Exam

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