Medical Billing Program
The Medical Billing program curriculum was developed by knowledgeable instructors with years of experience in their field. You'll learn real-world medical billing and claims procedures that are used in physician offices, hospitals and clinics so you can graduate ready to advance your career.
Lesson Group 1: Orientation: Ashworth College Career ProgramLearning at Ashworth
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 Group 2: Understanding Managed Care LearningIntroduction to Professional Billing and Coding Careers
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.
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.
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 Group 3: Medical CodingICD-9 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.
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.
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.
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 Group 4: Medical BillingPhysician 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.
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.
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.
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 Group 5: Accounts Receivable, Injury Claims, and Electronic Claims ProcessingExplanation of Benefits, Payment Adjudication, Refunds, and Appeals
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.
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.
Students learn the fundamentals of the medical billing and coding field. Program topics include insurance plans; medical ethics; HIPAA; ICD-9, ICD-10, CPT, and HCPCS coding; coding compliance and auditing; physician and hospital billing; Medicare, Medicaid, and TRICARE; EOBs, refunds, and appeals; workers’ compensation; and electronic claims processing.
After completing the Medical Billing program, students will be able to:
- Outline the typical responsibilities of a medical biller/coder, describe the personal and professional ethics required for success in this profession, and describe the career opportunities available to appropriately trained personnel.
- Describe the purpose and impact of the Health Care Portability and Accountability Act (HIPAA) and explain how medical professionals can learn about changes to the laws and regulations that affect them.
- Compare and contrast the major types of government and commercial insurance health plans, including Medicare, Medicaid, Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), and Point-of-Service (POS) plans.
- Describe the typical billing guidelines for inpatient medical, inpatient/outpatient global surgery, medical/surgical, and minor surgical procedures.
- Summarize the life cycle of a typical insurance claim and explain the processing steps that must be completed before claims and other forms can be submitted to the insurance company.
- Explain the purpose of medical coding and accurately code diagnoses and procedures using industry-standard coding systems published by the World Health Organization (WHO) and the American Medical Association (AMA).
Advance your skills for a better career in our Medical Billing program. Call 1-800-957-5412 or enroll online today.
*Certification Exam Requirements: Certification exam prerequisites vary. Please check with NHA for their requirements.