Online Class: Introduction to Medical Billing

In this medical billing course, you'll learn all about the basics of medical billing, such as: how to accurately complete claim forms, pay billing insurance companies, and adhere to each insurance carrier's policies and procedures.

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Course Description

Mastering Medical Billing: Your Pathway to a Rewarding Healthcare Career

The healthcare industry is a vast, dynamic, and essential sector, with myriad specialties and vocations. Among these, medical billing stands out as a critical cog in the medical machinery. As the healthcare sector continues to expand, the role of a proficient medical biller becomes increasingly indispensable.

Why Medical Billing?

In our interconnected world, where patient care seamlessly merges with technological advancements, the medical biller emerges as a bridge between healthcare providers and insurance companies. They play a quintessential role in ensuring the financial health of medical establishments. From processing insurance claims to adhering to ever-evolving healthcare policies, a medical biller's responsibilities are both diverse and integral. The demand for skilled medical billers has surged in recent years. Hospitals, clinics, and private practices rely heavily on adept billers to streamline their operations and maintain fiscal health.

What Will You Learn?

This comprehensive, self-paced course is meticulously crafted to arm you with the essential skills required to excel in medical billing. It's structured to suit both novices and those looking to brush up on their skills. Designed in accessible language, this course promises a deep dive into the intricate world of medical billing.

  1. Overview of the Healthcare System & Career Opportunities in Medical Billing (Lesson 1): Gain insights into the healthcare system's landscape and the exciting career paths open to medical billers.

  2. Medical Biller Job Description (Lesson 2): Delve into the specifics of what a medical biller does, understanding the nuances and intricacies of the role.

  3. Analyzing Provider and Patient Information (Lesson 3): Learn the art of dissecting critical data, ensuring accurate billing and top-notch patient care.

  4. ICD-10-CM - What is it? (Lesson 4): Get acquainted with the International Classification of Diseases, Tenth Edition, Clinical Modification - an essential tool for medical billing.

  5. Analyzing the Hospital Billing Process (Lesson 5): A deep dive into the billing process of hospitals, understanding the differences and nuances from other medical establishments.

  6. Analyzing the Physician Billing Process (Lesson 6): Gain a comprehensive view of how billing works specifically for physicians, unraveling the unique challenges and solutions.

  7. Exploring Different Types of Health Insurance (Lesson 7): Understand the diverse insurance types, ensuring effective communication with insurance providers.

  8. Medicare Overview (Lesson 8): Discover the workings of Medicare, one of the most significant health insurance programs.

  9. Reimbursement & Legal Issues (Lesson 9): Navigate the legal framework surrounding medical billing and understand the pivotal role of reimbursements.

  10. Medical Billing & Coding Certifications Information (Lesson 10): Explore the various certifications available, understanding their relevance and the advantages they bring to your career.

Why Choose This Course?

For those aspiring to make a mark in the healthcare administration domain, this course serves as a beacon. You will not only learn the technical aspects of medical billing but also cultivate a holistic understanding of its role in the broader healthcare spectrum. By the course's end, you'll be poised to seamlessly integrate into any medical establishment, wielding the dual weapons of knowledge and confidence.

In conclusion, if you're seeking a career that blends the gratification of being part of the healthcare industry with the satisfaction of a meticulous administrative role, medical billing is your answer. And this course, with its extensive curriculum and practical insights, is the perfect springboard to launch you into this rewarding profession.

Course Motivation

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
  • Self-Paced
  • 6 Months to Complete
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  • Start Anytime
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  • Accredited CEUs
Universal Class is an IACET Accredited Provider

Course Lessons

Average Lesson Rating:
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Lesson 1: Overview of the Healthcare System & Career Opportunities in Medical Billing

Overview of the Healthcare System and Career Opportunities in Medical Billing 4 Total Points
  • Lesson discussions: Reasons for Taking this Course
  • Assessment: Exam 1: Healthcare System Overview

Lesson 2: Medical Biller Job Description

Analyzing the job description and requirements of medical billers. 4 Total Points
  • Assessment: Exam 2: Medical Biller Duties

Lesson 3: Analyzing Provider and Patient Information

Analyzing Provider and Patient Information 5 Total Points
  • Assessment: Exam 3: Analyzing Provider and Patient Information

Lesson 4: ICD-10-CM - What is it?

What is ICD-10-CM - a comprehensive review. 10 Total Points
  • Assessment: Exam 4: ICD-10-CM - What is it?

Lesson 5: Analyzing the Hospital Billing Process

Analyzing the Hospital Billing Process 5 Total Points
  • Lesson discussions: Your Work Environment
  • Assessment: Exam 5: Hospital Billing

Lesson 6: Analyzing the Physician Billing Process

Analyzing the Physician Billing Process Additional lesson topics: OIG; Understanding Medical Necessity; CLIA BROCHURE DOWNLOADS; Become familiar with CLIA 33 Total Points
  • Lesson discussions: OIG Overview
  • Complete Assignment: WEB-BASED TRAINING- Medicare Billing: Form CMS-1500 and the 837 Professional
  • Complete Assignment: CMS.GOV - Learn about CLIA
  • Assessment: Exam 6: Physician Billing
  • Assessment: Claims Filing Tips & Guidelines
  • Assessment: CLIA Waived Tests

Lesson 7: Exploring Different Types of Health Insurance

Exploring Different Types of Health Insurance Additional lesson topics: What is a HMO Plan? Health Insurance Explained; Paying Healthcare Providers: The Impact of Provider Reimbursement on Overall Care; Tier Types; High Deductible Health Plan HDHP ; What's the Difference Between an HMO and a PPO? 9 Total Points
  • Complete Assignment: CMS video: Proper Documentation in Claims
  • Assessment: Exam 7: Types of Health Insurance

Lesson 8: Medicare Overview

Medicare Overview Additional lesson topics: Centers for Medicare and Medicaid Services CMS ; Services not Covered by Medicare; Preventive and Wellness Services Overview; Medicare Wellness Visits 24 Total Points
  • Complete Assignment: WEB-BASED TRAINING- World of Medicare
  • Assessment: Exam 8: Medicare
  • Assessment: Items & Services not Covered under Medicare

Lesson 9: Reimbursement & Legal Issues

Reimbursement & Legal Issues 45 Total Points
  • Review Practice Worksheet: MedicareFraudandAbusePresentationfr.ppt
  • Complete Assignment: WEB-BASED TRAINING- Combating Medicare Parts C and D Fraud, Waste, & Abuse
  • Complete Assignment: WEB-BASED TRAINING- Medicare Fraud & Abuse: Prevent, Detect, Report
  • Assessment: Exam 9: Legal Issues
  • Assessment: HIPAA

Lesson 10: Medical Billing & Coding Certifications Information

Medical Billing & Coding Certifications Information Additional lesson topics: Office of Inspector General OIG 0 Total Points
  • Lesson discussions: Course Completion Poll: Your Thoughts; Program Evaluation Follow-up Survey (End of Course); Course Comments
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.
  • Demonstrate mastery of lesson content at levels of 70% or higher.

Additional Course Information

Online CEU Certificate
  • Document Your Lifelong Learning Achievements
  • Earn an Official Certificate Documenting Course Hours and CEUs
  • Verify Your Certificate with a Unique Serial Number Online
  • View and Share Your Certificate Online or Download/Print as PDF
  • Display Your Certificate on Your Resume and Promote Your Achievements Using Social Media
Document Your CEUs on Your Resume
Course Title: Introduction to Medical Billing
Course Number: 7550400
Lessons Rating: 4.4 / 5 Stars (4,981 votes)
Languages: English - United States, Canada and other English speaking countries
Availability: This course is online and available in all 50 states including: California, Florida, Georgia, Illinois, New York, Pennsylvania, Ohio, Texas, and Washington.
Last Updated: July 2023
Course Type: 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
Syllabus: View Syllabus
Course Fee: $120.00 U.S. dollars

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