0017 - Medical Billing & Coding (Ed2Go Programs)

Course Description

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Whether you're just starting work or transitioning into a different field, there has never been a better time to enter a career in Medical Billing and Coding. This course will prepare you for success in this rewarding career as you learn about legal, ethical, and regulatory concepts central to this field, including HIPAA compliance, official coding guidelines, and third-party payer requirements. You will also be able to choose a voucher for the professional certification that best aligns with your interests and career goals.

More than one million practicing physicians in the United States rely on medical billers and coders to receive payment for their services. Besides medical facilities, positions are available with health insurance companies, specialty pharmacies, medical suppliers, consulting firms, and national medical coding and billing companies, so the opportunities are nearly endless!

Medical billers and coders are in high demand. This course offers valuable training in legal, ethical, and regulatory concepts central to this field, including HIPAA compliance, official coding guidelines, and third-party payer requirements. You will also come to understand all phases of the revenue cycle—from patient registration through medical coding, claims submission, reimbursement, and collections. You will also learn common medical terminology to help you converse with others in healthcare easily and with confidence. You will study word parts and the structures and functions of the human body. Also presented are the disorders and medical procedures common to each body system, including musculoskeletal, cardiovascular, respiratory, digestive, nervous, endocrine, integumentary, genitourinary, lymphatic, and immune.

After successfully completing the course requirements, you should be well prepared to find your place in this rewarding healthcare career. You will receive a Certificate of Completion from the school through which you enrolled, and you will also be able to choose a voucher for the professional certification that best aligns with your interests and career goals.

Certified Professional Coder (CPC) exam offered by the American Academy of Professional Coders (AAPC)
Certified Coding Associate (CCA) exam offered by the American Health Information Management Association (AHIMA)
Certified Billing and Coding Specialist (CBCS) exam offered by the National Healthcareer Association (NHA)

What you will learn

Medical Billing and Coding
Medical coding terminology is required for medical coding, including the structures and functions of the human body
The disorders and medical procedures common to each body system
Legal, ethical, and regulatory concepts central to the field, including HIPAA compliance and third-party guidelines for filing insurance claims
The main coding manuals: ICD-10-CM, ICD-10-PCS, CPT, and HCPCS Level II
How to code diagnoses, services, and procedures for all systems of the body
Fundamentals of medical billing & coding and medical terminology
Word parts and the structures and functions of the human body

How you will benefit

Get hands-on, practical experience in medical billing and coding that will help you on the job
Receive a certificate of completion and prepare to sit for the professional certification that best aligns with your interest and career goals
Receive a voucher for the professional certification exam of your choice
Receive access to study materials that align with the exam option you choose
Certified Professional Coder (CPC) exam offered by the American Academy of Professional Coders (AAPC)
Certified Coding Associate (CCA) exam offered by the American Health Information Management Association (AHIMA)
Certified Billing and Coding Specialist (CBCS) exam offered by the National Healthcareer Association (NHA)

Syllabus

Medical Terminology
1. Introduction to Medical Terminology
2. The Musculoskeletal System
3. The Cardiovascular System
4. The Lymphatic and Immune Systems
5. The Respiratory System
6. The Digestive System
7. The Urinary System
8. The Nervous System
9. The Special Senses The Eyes and Ears
10. The Integumentary System
11. The Endocrine System
12. The Reproductive System
13. Diagnostic Procedures, Nuclear Medicine, Pharmacology
Medical Billing and Coding
1. Introduction to Medical Billing and Coding
  1. Career Opportunities
  2. Personal and Technical Qualifications
  3. Employment Settings
  4. Telecommunications
  5. Professional Certifications
2. Introduction to Health Insurance
  1. Health Insurance Terminology
  2. Commercial and Government Payers
  3. Healthcare Documentation
  4. Electronic Health Record
3. Managed Healthcare
  1. Types of Reimbursement
  2. Managed Care Providers
  3. Managed Care Models
  4. Consumer-Directed Health Plans
4. Revenue Cycle Management
  1. Phases of Revenue Cycle Management
  2. Encounter Form, Chargemaster
  3. Insurance Claim Cycle
  4. New Patient Registration
  5. Collection Practices
5. Legal Aspects of Health Insurance and Reimbursement
  1. Laws Affecting Healthcare
  2. Protected Health Information
  3. Health Insurance Portability and Accountability Act (HIPAA)
  4. Fraud and Abuse in Medical Billing and Coding
  5. Release of Information
6. VI. ICD-10-CM Coding
  1. Overview of ICD-10-CM
  2. Key Features
  3. Organization of the Codebook
  4. Index to Diseases and Injuries
  5. Tabular List of Diseases and Injuries
  6. Coding Conventions
  7. Official Guidelines
7. CPT Coding
  1. Overview of Healthcare Common Procedure Coding System (HCPCS)
  2. Category I, Category II, and Category III Codes
  3. Organization of the Codebook
  4. Main CPT Sections
  5. Evaluation and Management
  6. Anesthesia
  7. Surgery
  8. Radiology
  9. Pathology and Laboratory
  10. Medicine
  11. Code Modifiers
8. HCPCS Level II Coding
  1. Overview of HCPCS Level II
  2. Organization of the Codebook
  3. Durable Medical Equipment
9. ICD-10-PCS Coding
  1. Overview of ICD-10-PCS
  2. Code Structure
  3. Definitions
  4. Index
  5. Code Tables
  6. Coding Steps
10. Pharmacology for Coders
  1. Pharmacodynamics and Pharmacokinetics
  2. Routes of Administration
  3. Drug Classifications
  4. Prescription Drugs and Over-the-Counter Drugs
  5. Controlled Substances
  6. Medication Lists and the Electronic Health Record
  MIDTERM
11. Clinical Documentation Improvement (CDI)
  1. Deficiencies in Documentation
  2. Medical Necessity
  3. Auditing
  4. Coding From Patient Documentation
12. Insurance Claims
  1. National Uniform Claim Committee
  2. CMS-1500 Claim Form
  3. Patient and Insured Information
  4. Physician or Supplier Information
  5. UB-04 Claim Form
13. Commercial Insurance
  1. Individual/Group Health Insurance, Automobile, Disability, Liability, Workers' Compensation
  2. Completing Commercial Health Insurance Claims
14. Blue Cross Blue Shield
  1. History of BCBS
  2. Types of BCBS Plans
  3. Participating/Nonparticipating Providers
  4. BCBS Billing and Payment Guidelines
15. Medicare
  1. Medicare Eligibility
  2. Medicare Part A, B, C, and D
  3. National Coverage Determinations/Local Coverage Determinations
  4. Participating/Nonparticipating Providers
  5. Physician Fee Schedule
  6. Medicare Billing and Payment Guidelines/NCCI
16. Medicaid, CHIP, TRICARE, Workers' Compensation
  1. Medicaid
  2. Children's Health Insurance Program (CHIP)
  3. TRICARE
  4. Workers' Compensation
17. Certification
  1. Selecting the Right Certification
  2. Study Strategies for the Certification Exam
  3. Prior to the Exam
  4. Morning of the Exam
  5. During the Exam
18. How to Find a Job in Medical Billing and Coding
  1. Formulating Your Career Goals
  2. What Employers Want
  3. Showcasing Your Skills
  4. Resume Tips
  5. Cover Letter Tips
  6. Interview Questions
FINAL