Lesson 1: Learning at Ashworth
Lesson 2: Allied Health Careers
The goals and values of Ashworth College; time management; creating a realistic weekly and monthly study schedule; the nature and purpose of assessments; how to study effectively to prepare for and take an online examination; developing the skill sets necessary for success in the twenty-first century.
Lesson 3: Medical Terminology
Introduction to the basic operations of allied health careers and the legal and ethical issues you may encounter while working in the many different venues available for these fields.
Lesson 4: Body Systems 1
Fundamentals and origins of medical terms; analyzing, defining, and creating medical terms; identifying major body structures and directional terms.
Lesson 5: Body Systems 2
Anatomy, physiology, and basic terminology related to the integumentary, musculoskeletal, digestive, cardiovascular, lymphatic, respiratory, endocrine, and nervous systems.
Lesson 6: Introduction to Professional Billing and Coding Careers
Anatomy, physiology, and basic terminology related to the urinary and reproductive systems; gynecology, obstetrics, and neonatology terms and conditions; anatomy of the eyes and ears.
Lesson 7: Insurance Plans
An introduction to the different types of facilities that employ allied health personnel; job descriptions pertaining to billing and coding careers; options available for certification.
Lesson 8: Medical Contracts, Ethics, and HIPAA
The history and impact of managed care; the organization of managed care and its effect on the provider, employee, and policyholder; patient financial responsibility; types of managed care plans and insurance coverage.
Lesson 9: ICD-9-CM Coding
Key elements of managed care contracts; covered services for patients, including preventive medical services and office visits; protected health information; patient information disclosure; HIPAA security standards and regulations compliance; HITECH and EHRs.
Lesson 10: ICD-10-CM Coding
History of coding; purpose of ICD-9-CM; abbreviations, symbols, typefaces, punctuation, and formatting conventions; correct code assignment; nine steps of accurate coding.
Lesson 11: CPT and Place-of-Service Coding; Coding Procedures and Services
Similarities and differences between ICD-9 and ICD-10 codes; differences between a crosswalk and mapping; general ICD-10 coding guidelines; new features in ICD-10-PCS.
Lesson 12: HCPCS, Coding Compliance, and Auditing
History of CPT; evaluation and management (E/M) services and code assignment; CPT categories; modifiers and add-ons; using the CPT index; code ranges and conventions.
Lesson 13: Physician Medical Billing
Two levels of HCPCS coding; modifiers; interpreting and identifying correct code linkages; reviewing codes for accuracy; federal laws, regulations, and penalties pertaining to coding compliance; the National Correct Coding Initiative; medical ethics for coders; implementing a coding audit; reviewing and analyzing medical records; content and documentation requirements.
Lesson 14: Hospital Medical Billing
Completing medical claim forms accurately, both manually and electronically; defining claim form parts, sections, and required information; the CMS-1500 claim form; reasons why claim forms are delayed or rejected; filing a secondary claim.
Lesson 15: Medicare
The hospital inpatient billing process; submitting accurate and timely hospital claims and practicing good follow-up and collection techniques; differentiating between inpatient and outpatient services; the UB-04 (CMS-1450) hospital billing claim form.
Lesson 16: Medicaid and TRICARE
Government billing guidelines; determining the amount due from a patient for a participating provider; Medicare fee schedules; completing accurate Medicare forms; identifying types of Medicare fraud and abuse.
Lesson 17: Explanation of Benefits, Payment Adjudication, Refunds, and Appeals
Requirements for qualifying to receive Medicaid benefits; determining the schedule of benefits a Medicaid recipient will receive; verifying Medicaid benefits; submitting a Medicaid claim and deciphering claim status; determining TRICARE eligibility; types of benefits available to veterans and their families; submitting claims to TRICARE using the CMS-1500 and UB-04 forms.
Lesson 18: Workers' Compensation
Steps necessary for filing a medical claim; the importance of the Explanation of Benefits and Electronic Remittance Advice forms; calculating accurate payment by a carrier or third-party payer; making adjustments to patient accounts; reviewing reason codes; common problems and solutions for denied or delayed payments; formatting medical records with proper documentation; registering a formal appeal; ERISA rules and regulations; refund guidelines; rebilling insurance claims; three levels of Medicare appeals; calculating and issuing refunds.
Lesson 19: Electronic Claims Processing
The history of workers' compensation; federal workers' compensation versus state workers' compensation; classifications of work-related injuries; injured workers' responsibilities and rights; responsibilities of the treating doctor/physician; the role of an ombudsman; four types of workers' compensation benefits; different types of disability; completing a CMS-1500 form for a workers' compensation claim; determining the workers' compensation fee schedule based on the Medicare Fee Schedule.
Entering patient demographic information and posting charges, payments, and adjustments using medical practice management software; printing a walkout receipt for each patient who has charges posted to his or her account; balancing the batch at the end of the day; printing insurance claim forms for patients who are covered by insurance.
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