Course Syllabus: Introduction to Medical Billing


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Course Description

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, out paces 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.
 
 
Needless to say, there is a great need for Medical Billers and Medical Coders. In this course you're going to learn all about medical billing from the ground-up. The instructor assumes you have little or no knowledge about medical billing.
 
Written in "laymen's terms", this class is an ideal preparation course for any person interested in this booming area.  Our easy-to-use online format will suit your lifestyle and schedule.  Classes require no special software or hardware and best of all, you study at your convenience, day or night, anywhere in the world.

Course Outline

Lesson One: OVERVIEW OF HEALTHCARE SYSTEM AND CAREER OPPORTUNITIES IN MEDICAL BILLING
A. Healthcare Industry Employment Statistics
B. Education & Training
C. Environment
D. Healthcare Employment Outlook
E. Medical Billers On the Rise
F. Distinction between Billers and Coders
G. Medical Biller: Job Description

Lesson Two: PROVIDER AND PATIENT INFORMATION
A. Medical Biller: Subset of Knowledge
B. Medical Terminology
C. AMA's Current Procedural Terminology (CPT)
D. Third Party Payers (Insurance Companies)

Lesson Three: HOSPITAL BILLING
A. Hospital Setting
B. Hospital Bill
C. Hospital ChargeMaster
D. 'Usual and Customary'
E. Healthcare Price Transparency Act of 2006

Lesson Four: BILLING THE VISIT
A. Medical Treatment & Billing Process
B. Paper Trail
C. Intermediary Clearinghouse
D. Carrier Receipt of Claim
E. Medical Software
F. HIPAA
G. Establishing Rates
H. Billing Discrepancies
I. Compliance/Billing Submissions
J. Post-Payment Audits
K. billingwiki.com

Lesson FIVE: DIFFERENT TYPES OF HEALTH INSURANCE
A. Four Basic Types of Plan
B. Traditional Indemnity/Fee-for-Service Plan
C. Managed Care
D. Preferred Provider Organization (PPOs)
E. Point-of-Service Plans (POS)
F. Health Management Organizations (HMOs)
G. Short-Term Health Insurance Plans
H. Comprehensive Plan
I. Travel Medical
J. International Student Insurance

Lesson SIX: MEDICARE OVERVIEW
A. Medicare: What It Is
B. Medicare: History
C. Bush Politics & Medicare
D. Medicare: How It Works
E. Medicare: Enrollment
F. Medicare: Types of Plans
G. Medicare: Billing Process
H. Medicare: Appeals Process
I. Medicare: What's New

Lesson Seven: LEGAL ISSUES
A. Current Healthcare Climate
B. HIPAA Consumer Protections
C. Compliance with HIPAA
D. Oversights versus Outright Fraud
E. Insurance Company & Reimbursements

Lesson 8: CERTIFICATION INFORMATION
A. Medical Billers: Making the Grade
B. Certified Medical Reimbursement Specialist (CMRS)
C. CMRS Exam
D. CMRS Study & Resources

Course Requirements

The only requirement you'll need is a high school reading level in English.  There are no required books for this course.  All material will be given online.

Grading Policy

There are quizzes and/or assignments at the ends of lessons which the instructor will review and grade.  All grades are percentage grades.

Recommended Books

There are no Required books for this course.  These are Recommended books for further study:
 
 
1.  Medical Billing 101 (Paperback)  Link to: Medical Billing 101
 
2.Webster's New World Medical Dictionary (2nd Edition) (Paperback) Link to Webster's Med. Term Dictionary
 
3.Medical Terminology Flash Cards: 1000 Cards (Quick Study) (Cards) Link to Med Term Flash Cards
 
 

Learning Outcomes

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

Creating your Account on MLN / CMS10
Exam 1 : Healthcare System Overview5
Qualifications of a Medical Biller10
Exam 2: Medical Biller Duties4
Exam 3: Analyzing Provider and Patient Information5
Exam 4: Hospital Billing5
Best Practices for Corrected Claim Filing10
CMS Provider Minute: Duplicate Professional Claims10
The Levels of Claim Appeals10
Medicare Billing Form CMS-1500 and the 837 Professional10
Acute Care and the IPPS10
In physician Lab Offices10
Exam 5: Physician Billing6
Claims Filing Tips & Guidelines10
CLIA Waived Tests20
Exam 6: Types of Health Insurance5
World of Medicare or Your Office in World of Medicare10
Your Institution in the World of Medicare10
Items & Services not covered under Medicare10
Exam 7: Medicare5
Items & Services not Covered under Medicare10
HIPAA Interactive Exercise10
Medicare Fraud & Abuse: A Roadmap for Physicians10
Exam 8: Legal Issues5
HIPAA30
Total Points:240
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