Introduction to Medical Billing

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Course Description

Medical billing is one of the fastest growing healthcare jobs.  Hospitals, private practices and clinics could not survive without someone who efficiently handles their day-to-day Medical Billing procedures. A medical biller's job responsibilities can include: expert management of healthcare billing--processing, adjusting and resubmitting of claims; adherence to current healthcare industry regulations and policies; and compliance with insurance procedures and allotted benefit coverage.  This self-paced course will quickly and easily train you in these procedures.
There is a great need for medical billers.  In this course you're going to learn all about medical billing from the ground-up. This course assumes you have little or no knowledge about medical billing. Written in "layman's terms", this course is an ideal preparation course for any persons interested in this booming area in the health and medical administration industry.

Healthcare Industry Employment Statistics
For those interested in pursuing a healthcare profession, the wide array of career opportunities can be staggering.  From physicians and RNs, to administrators and medical assistants, there are many avenues worth pursuing.
The US healthcare system is one of the fastest growing careers and is the one industry projected in the coming decade to create the largest number of new jobs.

Healthcare and social assistance. "The healthcare and social assistance industry is projected to create about 28 percent of all new jobs created in the U.S. economy. This industry which includes public and private hospitals, nursing and residential care facilities, and individual and family services is expected to grow by 33 percent, or 5.7 million new jobs. Employment growth will be driven by an aging population and longer life expectancies, as well as new treatments and technologies" (United States Department of Labor, 2012).  

Education & Training
Within the healthcare industry, there exists great disparity among the required education levels of jobs. For instance, while there are many positions which require less than four years of college, there are also a large number of specialty positions, i.e. physicians, diagnosticians, anesthesiologists, requiring a great deal more education than 4 years of college. And, along with the service and professional positions, accounting for 18 percent of the healthcare workforce, there are also office and administrative support positions.

Healthcare workers may be employed within any one of the approximately half a million plus establishments which comprise the healthcare industry. In total, the varying healthcare establishments vary greatly in terms of size, staffing patterns, and organizational structures.

More than 75 percent of the healthcare establishments are offices of physicians, dentists, or other health practitioners, and while hospitals constitute only 2 percent of all healthcare establishments, they employ nearly 40 percent of all the healthcare workers.

In addition to private offices and hospitals, additional healthcare establishments include: outpatient care centers, medical diagnostic laboratories, ambulatory service areas and nursing residential care facilities.

As healthcare facilities cannot keep regular business hours, healthcare professionals (depending on their position) may be expected to cover shifts around the clock, as well as all calendar days.


Healthcare Employment Outlook

Due to high job turnover, job opportunities within the healthcare industry are incredibly favorable. This is due to the large number of healthcare personnel anticipated to retire, as well as the stricter enforcement of immigration laws preventing foreign healthcare workers from entering the United States.

As indicated by economic determinants, wages and salary pay rates within the healthcare industry are projected to increase 27 percent through 2018. This is nearly double the rate of increase (14 percent on average) for all of the other industries.

Expanding the workforce, employment growth within the healthcare sector is expected to bring about more than 3.6 million new wage and salary jobs (this is 19 percent of all the wage and salary jobs being added to the economy during the course of the coming decade).

Specifically, the projected rates of employment growth for the healthcare industry include: 13 percent in hospitals (the largest and slowest growing segment of the industry) to 69 percent in the home healthcare (a much smaller segment) service arena.


Medical Billers on the Rise

Each year, in the United States, healthcare insurers process over 5 billion claims for payment.

Healthcare in America is an explosive industry accounting for the top 3 producers in gross national product (and income), and, outside of a few industrial sectors, outpaces all other industries in terms of its projected growth.

Grouped within the healthcare sector known as Health Information Management (HIM) , health information technicians (the group to which coders belong) are projected to be one of the 20 fastest growing occupations in the US.

Within the coming decade, four million jobs within the healthcare industry will open up with many of these positions existing outside of the traditional care-giving arena, e.g., consulting, claims-review, and auditing firms. Because of the fact that medical billing (specifically the coding component) is significantly specialized, they will remain in very high demand.

Healthcare costs are excessively high and both insurance companies and the government are willing to invest more time and money to ensure their dollars are properly spent. Specifically, they are willing to spend more on the research process so that they are better equipped to control fraudulent claims, mitigate abusive practices, and clearly identify conditions which qualify as medical necessities.

With such an eagle-eye focus on healthcare billing issues, the majority of companies and private practices desire to hire candidates with experience in the field and/or have obtained specialty schooling. Individuals with such qualifications are preferred for they are less apt to fall into the legal pitfall trap associated with incorrect billing practices. As an added precaution, companies and private practices have opted to take out coding insurance for their medical billing documentation specialists.

While vocabulary terms for this occupation can vary from medical biller/coder to health insurance specialist, the core responsibility of submitting medical claims for reimbursement remains the same.
Distinction between Billers and Coders 

Both medical billers and coders share the common purpose of facilitating the financial reporting and invoicing side of the healthcare industry. They differ, though, in that:

1.   Medical billers tend to prepare billing documentation for physicians and healthcare agencies which, in turn, are submitted to insurance agencies whereas
2.   Medical coders tend to work for the overarching insurance companies and public healthcare organizations (e.g., HMOs and PPOs).

And while medical billers may work out of their home, medical coders, more often than not, work in an office-type setting within a more formalized corporate environment.  But it is not impossible for one person to facilitate both roles: that of a medical biller and a medical coder and, furthermore, that person could do so from the confines of their own home-based business.

Many positions within the financial healthcare sector entail medical billers and medical coders. These professionals may operate out of their own home-based business or they could work out of physicians' private offices, hospital settings, pharmacies, nursing/residential care facilities, rehabilitation institutes, and/or medical laboratories. With added licensing to their credentials, they may also act as insurance specialists, accounting specialists, and/or consultants.

Medical Biller: Job Description

While a medical biller's job responsibilities can extend to many other areas, the crux of their duties include:
1. Expert management of healthcare billing--processing,
2. Adjusting and resubmitting of claims;
3. Adherence to current healthcare industry regulations and policies; and
4. Compliance with insurance procedures and allotted benefit coverage.
In order to expedite such tasks, the following are the principal 'core knowledge areas' over which a medical biller needs to possess competency:

1. Compliance with acceptable regulatory and billing practices;
2. Familiarity with varying fee schedules, claims forms and collection methods; and
3. Compliance with health insurance coverage areas.
And, to work in adherence with formalized policies, the medical biller needs to profess proficiency working with the American Medical Association's (AMA) Current Procedural Terminology (CPT).

CPT then is the language of medical billers and coders; it encompasses all of the shorthand abbreviations written down in a patient's chart indicating the medical services and treatments that were provided. 
a.  A medical biller should possess strong customer service skills;

b.  Be proficient in accounting, bookkeeping, and word processing;
c.  Quickly be able to digest new regulatory rulings and revised health insurance company policies;
d.  Be able to type a minimum of 45 words per minute, and
e.  Possess familiarity with fee structures, as well as, medical terminology, procedures and correlative coding.
A medical biller's job success is contingent upon their abilities to multi-task and complete an on-going series of logistical details.
While one project may come to a close, there will always be a multitude of others in varying stages of completion. The successful medical biller must always be adaptable to juggling many unfinished tasks every day instead of achieving total closure on all open projects each day or week.

Did you know that every year in the United States alone that healthcare insurers process over 5 billion claims for payment?  Right now, healthcare in America is an explosive industry and with the upcoming Presidential elections, once again, healthcare is on everyone's mind.  There has never been a better time for individuals who are looking for terrific employment opportunities to enter the workforce with specialized skills in the medical field.

Right now, within the health care sector known as Health Information Management (HIM), health information technicians (which are the coders who are involved with medical billing) are projected to be one of the 20 fastest growing occupations in the United States.

In addition to that, four million jobs within the healthcare industry will open and medical billing is one area that is going to remain in very high demand.

This course is designed for those people who have little or no knowledge about medical billing.  You will be walked through every step of the process and it will be presented in layman's terms.  In other words, you don't need a medical degree to understand what this course will teach you just a desire to expand your knowledge. 

There has never been a better time to take advantage of the tremendous opportunities that are available and this course will provide an ideal preparation environment for anyone interested in this booming area in the health and medical administration industry.  This is a perfect first step for someone looking to find a new employment opportunity that is both rewarding and exciting.

The student who takes this course will gain an understanding of the healthcare industry and what it takes to be involved with medical billing.  With both online forums and with email support from the instructor, students will be able to expand their knowledge and expertise.  This is an ideal way for someone involved in fields such as insurance to expand their knowledge of the billing process and take that knowledge further in their own company.

Students will be exposed to such areas as:

        Overview of healthcare system and career opportunities in medical billing:  Students will be given the employment statistics for the healthcare industry, as well as understand the importance of education and training and discover where those opportunities exist.  In addition, they will see how medical billers are on the rise and learn the difference between medical billers and medical coders.

        Provider and patient information:  The student will learn more about what it means to be a medical biller, as well as gain some medical terminology, and explore what third party payers are and how they fit into the overall picture of medical billing.

        Hospital billing:  Students will learn about the ways that hospitals handle their billing procedures and will explore such aspects as the hospital chargemaster and examine the Healthcare Price Transparency Act.

        Billing the visit:  The student will learn about the billing process as it relates to medical treatment and will explore how to deal with establishing rates, what to do in the event of a billing discrepancy, as well as examine how billing is submitted and what a post-payment audit is.

        Different types of health insurance:  Students will examine the four basic types of plans, and will investigate the differences between them, as well as understanding which plan a client possesses.

        Medicare overview:  The student will learn what Medicare is, as well as the history of Medicare and how it currently works.  Enrollment in Medicare will be addressed, as well as how the billing process works also taking a close look at the appeals process and what is new in the Medicare program.

        Legal issues:  As with anything involving the medical community, emphasis should be paid to such aspect as legal issues.  Students will examine the current healthcare climate and learn what protections are given to consumers today.  Compliance with Health Insurance Portability and Accountability Act (HIPAA) will be addressed, as well as the difference between a billing oversight and outright fraud.  Students will also examine the insurance company reimbursement process.

        Certification information:  Students will learn what it takes to make the grade as a medical biller, as well as the requirements for becoming a certified medical reimbursement specialist (CMRS) and what is in the CMRS exam and where students can get more information on studying for it.

Although it might appear to be complex, this course is actually very easy to understand and there is always a wealth of information that can be shared through either online forums or with the instructor. 

  • Completely Online
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  • 6 Months to Complete
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Universal Class is an IACET Accredited Provider

Course Lessons

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Lesson 1: Overview of the Healthcare System and Career Opportunities in Medical BIlling

Overview of the Healthcare System and Career Opportunities in Medical Billing 15 Total Points
  • Take Survey: Reasons for Taking this Course
  • Complete Assignment: Creating your Account on MLN / CMS
  • Complete: Exam 1 : Healthcare System Overview

Lesson 2: Medical Biller Job Description

Analyzing the job description and requirements of medical billers. 14 Total Points
  • Complete Assignment: Qualifications of a Medical Biller
  • Complete: Exam 2: Medical Biller Duties

Lesson 3: Analyzing Provider and Patient Information

Analyzing Provider and Patient Information 5 Total Points
  • Review Article: AMA
  • Take Poll: First Step to accessing the CMS Website
  • Complete: Exam 3: Analyzing Provider and Patient Information

Lesson 4: Analyzing the Hospital Billing Process

Analyzing the Hospital Billing Process 15 Total Points
  • Take Poll: Your Work Environment
  • Complete Assignment: Acute Care and the IPPS
  • Complete: Exam 4: Hospital Billing

Lesson 5: Analyzing the Physician Billing Process

Analyzing the Physician Billing Process 86 Total Points
  • Review Article: OIG - Office of the Inspector General
  • Take Poll: OIG Overview
  • Complete Assignment: Best Practices for Corrected Claim Filing
  • Complete Assignment: CMS Provider Minute: Duplicate Professional Claims
  • Complete Assignment: The Levels of Claim Appeals
  • Complete Assignment: Medicare Billing Form CMS-1500 and the 837 Professional
  • Complete Assignment: In physician Lab Offices
  • Complete: Exam 5: Physician Billing
  • Complete Exam: Claims Filing Tips & Guidelines
  • Complete Exam: CLIA Waived Tests

Lesson 6: Exploring Different Types of Health Insurance

Exploring Different Types of Health Insurance 5 Total Points
  • Complete: Exam 6: Types of Health Insurance

Lesson 7: Medicare Overview

Medicare Overview 45 Total Points
  • Complete Assignment: World of Medicare or Your Office in World of Medicare
  • Complete Assignment: Your Institution in the World of Medicare
  • Complete Assignment: Items & Services not covered under Medicare
  • Complete: Exam 7: Medicare
  • Complete Exam: Items & Services not Covered under Medicare

Lesson 8: Legal Issues

Legal Issues 55 Total Points
  • Review Practice Worksheet: MedicareFraudandAbusePresentationfr.ppt
  • Review Article: Caught on Tape - Medicare Fraud
  • Complete Assignment: HIPAA Interactive Exercise
  • Complete Assignment: Medicare Fraud & Abuse: A Roadmap for Physicians
  • Complete: Exam 8: Legal Issues
  • Complete Exam: HIPAA

Lesson 9: Medical Billing Certification Information

Medical Billing Certification Information 0 Total Points
  • Take Poll: Course Completion Poll: Your Thoughts
  • Take Survey: Program Evaluation Follow-up Survey (End of Course)
Total Course Points

Learning Outcomes

By successfully completing this course, students will be able to:
  • Summarize the healthcare system and career opportunities in medical billing.
  • Summarize the medical biller job description.
  • Analyze provider and patient information.
  • Analyze the hospital billing process.
  • Describe billing the patient visit.
  • Summarize the different types of health insurance.
  • Summarize what Medicare is and how to bill it correctly.
  • Define legal issues, and
  • Demonstrate mastery of lesson content at levels of 70% or higher.

Additional Course Information

Online CEU Certificate
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Document Your CEUs on Your Resume
Course Title: Introduction to Medical Billing
Course Number: 7550400
Languages: English - United States, Canada and other English speaking countries
Course Type: Professional Development (Self-Paced, Online Class)
CEU Value: 1.7 IACET CEUs (Continuing Education Units)
CE Accreditation: Universal Class, Inc. has been accredited as an Authorized Provider by the International Association for Continuing Education and Training (IACET).
Grading Policy: Earn a final grade of 70% or higher to receive an online/downloadable CEU Certification documenting CEUs earned.
Assessment Method: Lesson assignments and review exams
Instructor: Diana Wilson, CPC, CPC-I, CPMA
Syllabus: View Syllabus
Duration: Continuous: Enroll anytime!
Course Fee: $85.00 (no CEU Certification) || with Online CEU Certification: $110.00

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