Medical Billing and Claims
Career Diploma

Medical word building; the roles of prefixes, combining forms and suffixes; body directions, planes and cavities; the major body systems; terms used to describe cells, tissues and glands; medical specialties.

Major structures and functions of the integumentary system; terms used to describe the diagnosis, pathology and treatment of skin disorders.

The major structures and functions of the skeletal and muscular systems; types of joints and muscles; terms related to the diagnosis, pathology and treatment of the skeletal and muscular systems.

Major structures and functions of the digestive system; terminology related to the diagnosis, pathology and treatment of digestive illnesses.

Major structures and functions of the cardiovascular, lymphatic and immune systems; types and functions of blood vessels; terms related to the diagnosis, pathology and treatment of the cardiovascular, lymphatic and immune systems.

Major structures and functions of the respiratory and nervous systems; major parts of the brain by location and function; diagnosis, pathology and treatment terms relating to the respiratory and nervous systems.

Major structures and functions of the urinary and endocrine systems; terms used to describe the diagnosis, pathology and treatment of urinary and endocrine gland disorders; the hypothalamus and endocrine glands; functions of the hormones secreted by the glands.

Major structures and functions of the eyes and ears; terms describing the diagnosis, pathology and treatment of eye and ear disorders.

Major functions and structures of the male and female reproductive systems; terms relating to the diagnosis, pathology and treatment of male and female reproductive disorders.

Cancer classifications; diagnosing cancer; cancer treatment and prevention; dangers and safety precautions associated with x-rays; diagnostic and therapeutic benefits of radiology and nuclear medicine.

Types of insurance plans; disability and liability insurance; major developments in health insurance; the six managed care models; HMO accreditation; government- managed care ventures; the effect of managed care on administrative procedures.

New patient interview and check-in procedures; established patient return visits; post-clinical check-out; computerized practice procedure methods; introduction to ICD-9-CM and CPT coding; insurance company claims processing; the legal and regulatory considerations of an insurance claim.

Billing guidelines for inpatient medical, in/outpatient global surgery, minor surgery, and maintenance of a provider's claim files; setting up a filing system for completed claims; determining primary and secondary status; completing common types of claims.

History and function of BCBS plans; features of BCBS basic benefits; typical services in major medical coverage including identifying patients and the correct procedure for completed a BCBS claim form.

Parts of the Medicare program; eligibility criteria; fee schedule; supplemental plans and managed care; filling out an HCFA 1500 claim form.

Who is eligible for Medicaid; services covered under the federal portion of Medicaid; services provided and paid for by state coverage; steps to obtain preauthorization services.

Health care for the military; deductibles, cost sharing and eligibility requirements for TRICARE; filing TRICARE claim forms; workers' compensation programs; classifying on-the-job injuries; preparing a First Report of Injury form; qualifying for workers' compensation benefits.

Using the ICD-9-CM coding system; primary vs. principal diagnosis; ICD-9-CM terms, marks, abbreviations and symbols; index tables.

Basic format of CPT service and procedure codes on the CMS-1500 claim; comparing CPT with ICD-9-CM coding; modifiers; new vs. established patient; assigning emergency department and critical care codes; consultation vs. confirmatory visit; preventive medicine visits; the global surgical period.

The HCPCS system for reporting professional services, procedures, supplies and equipment; HCPCS level II coding system; CMS reimbursement; rules of the Medicare physician fee schedule payment system.

How to code from patient medical records; the importance of correct physician documentation; steps in coding an operative report; selecting and coding diagnoses and procedures from case studies and sample records.