|
|
MEDICAL CLAIMS & BILLING COURSE OUTLINE
|
 
You get everything you need to know in easy-to-understand lessons that take you step-by-step from the basics of medical terminology, anatomy, and diagnosis and treatment of disease, through coding procedures and processing medical claims. This gives you a preview of what you will learn.
Click on the instruction links below for complete course content.
Instruction Pack 1
Instruction Pack 2
Instruction Pack 3
Instruction Pack 4
Instruction Pack 5
Medical Claims & Billing Instruction Pack I Back to Top
The Exciting World of Medicine and Medical Claims
Your first lesson introduces you tot he basic concepts of medical billing. You will get an overview of the billing process as a whole, from the checking in of the patient at reception to the reimbursement of the doctor for services rendered.
The Third-Party Payer: How Insurance Works
In this lesson, you will gain a strong foundation in the language of health insurance. You will become familiar with the types of health insurance programs in existences today, including government-sponsored health plans, workers' compensation and managed care programs.
Handling Claims
Important insurance concepts are covered in this lesson, including preauthorization and diagnostic and procedure coding. You will also learn about checking up on claims: when follow-up is warranted, what information to have in hand when contacting insurance companies, and proper procedures to use for follow-up.
Career Opportunities as a Medical Billing Specialist
Many different career options are open to the medical claims and billing specialist. This lesson explores those options with you, and you can begin to assess which career is the best fit for your work style.
Medical TerminologyWord Parts
Medicine has its own language. In this lesson, you will discover the basic building bocks of all medical terms: root words, prefixes and suffixes. These building blocks will allow you to understand even the most complex medical term.
Medical Terminology-Dividing and Combining Medical Terms
Continue your study of the language of medicine. You will learn the specific rules of dividing a medical term into its word parts so you arrive at the correct meaning. You will also learn how to combine the word parts to form medical terms.
Also included in Pack I:
• Course Introduction
• School Catalog
• Medical Claims Glossary
• Quick-Learn Kit, including Audiotape and Flashcards
• Quiz Answer Sheets and Envelopes
• Student Assistance Forms
• Course Organizer #1
Medical Claims & Billing Instruction Pack II Back to Top
Abbreviations, Symbols and Special Terms
In this lesson, you will learn about the abbreviations, acronyms and symbols commonly used in medicine. Medical eponyms, sound-alikes, opposites and the special rules regarding medical plurals will also be covered.
Introduction to Anatomy
The basic concepts of anatomy and physiology are important to everyone working in the field of medicine. This lesson explains the relationships among anatomy, physiology and pathology.
The Anatomy of the Human Body
This lesson gives detailed instruction on the anatomy of the human body in terms of landmarks, divisions, and cavities. You will read about the organization of the body from cells and tissues to organs and organ systems.
Organ Systems I
Five organ systems are covered in this lesson: musculoskeletal, neurological, cardiovascular, immune and integumentary (skin). You will learn about the specific characteristics of each system, its function, its parts and how it works to make the whole body function properly.
Organ Systems II
The five remaining organ systemsrespiratory, gastrointestinal, genitourinary (male), reproductive (female), and endocrine (glands)are discussed. This lesson describes the process of each of these systems, its parts and how it contributes to the whole body.
Medicaid and Medicare
In this lesson, you will find out about the government-sponsored programs of Medicaid and Medicare. In addition, you will lean about Medigap and Medi-Medi insurance, and will be introduced to the HCPCS system of coding.
Also included in Pack II:
• Human Anatomy Flashcards
• Quiz Answer Sheets and Envelopes
• Additional instruction applying the Quick-Learn Kit with Audiotapes and Flashcards
Medical Claims & Billing Instruction Pack III Back to Top
Private Insurance and Managed Care Programs
This lesson explains the characteristics of private and group health care insurance programs. You also are given an overview of managed care programs and how they work, including discussions HMOs, PPOs, POS (point of service) plans and PPGs (physician provider groups).
Military Insurance and Workers Compensation
The options of medical coverage offered through TRICARE and CHAMPVA are presented in this lesson. You will also read about the difference between workers' compensation and disability insurance. Further, you will learn the steps required for filing claims in all of these special insurance situations.
Diagnostic (ICD-9-CM) Coding
This lesson will lead you step-by-step through the International Classification of Diseases (ICD) and how to use the ICD-9-CM to correctly code a physician's diagnosis. You will discover how to handle coding in certain important situations, such as those involving an unconfirmed diagnosis, multiple diagnoses and late effects coding.
Procedure Coding
This lesson gives detailed instructions for completing the HCFA-1500 insurance claim form. The special considerations necessary for Medicare and Medicaid are included in the line-by-line explanations for each of the 33 fields.
Integrating ICD-9-CM and CPT Codes
In this lesson, you will learn how to integrate ICD-9-CM and CPT codes and will practice assigning them to patient scenarios. You will also receive instruction on inserting ICD-9-CM and CPT codes on HCFA-1500 claim forms.
Determining Payment
There are many methods used to determine the amount reimbursed to providers. You will learn about the usual, customary and reasonable standard, fee schedules and relative value studies, as well as the difference between diagnostic related groups (DRGs) and ambulatory payment classifications (APCs).
Also included in Pack III:
• ICD-9 Condensed Coding Manual
• Your Family and Working at Home Supplement
• Quiz Answer Sheets and Return Envelopes
• Coding Quick Reference Card
Medical Claims & Billing Instruction Pack IV Back to Top
Preparing the HCFA-1500 Claim Form for Various Carriers
Review processing the HCFA-1500 forms, confidential physician files, and confidential patient forms. Then you will use your new knowledge as you complete the claim form for various carriers in extensive, hands-on practice.
Preparing the UB-92 (HCFA-1450) Claim Form
The UB-92 insurance form is primarily used in hospitals. You will receive detailed instructions on completing UB-92, with line-by-line explanations and examples of the proper way to fill in all 86 fields.
Electronic Billing
This lesson provides valuable instruction on handling electronic claims submissions. You will learn about carrier-direct claim submissions, clearinghouses and setting up electronic claims contracts. You will also learn about the Health Insurance Portability and Accountability Act (HIPAA) and how that Act affects electronic claims.
Also included in Pack IV:
• ComputersA Buyers and Users Guide
• Claims Resource Supplement
• Quiz Answer Sheets and Envelopes
Medical Claims & Billing Instruction Pack V Back to Top
Interpreting EOB Statements
This lesson will enable you to read and understand the explanation of benefits received from various insurance carriers.
Secondary Claims and Managing Accounts
In this lesson, you will learn about preparing secondary claims, and you will read about accounts receivable and insurance logs. In addition, you will be given valuable tips on effectively managing patient and client accounts.
Solving Problems with Insurance Claims, Physicians and Patients
This lesson shows the steps to use in dealing with insurance companies and patients when there is a problem with a claim or bill. You will be provided instruction on following through on insurance problems, solving patient problems and solving problems with doctors.
• Medisoft Electronic Claims SoftwareEducational Version
Legal Issues Affecting Medical Claims and Records
Anyone working in the medical field must clearly understand the ethical issues involved in working with private health information. In this lesson, you will read about fraud, liability insurance coverage, insurance audits, malpractice claims and, under the requirements of HIPAA, the special responsibilities that you have to protect a patient's privacy. The concepts and skills learned throughout this course are brought together in a final exam.
Also included in Pack V:
• Medical Claims and Billing Jobs Finder
• Course Organizer #2
• Quiz Answer Sheets and Envelopes
|
|
