Medical Billing and Coding

1. 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
2. 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. ICD-10-CM Coding
      1. Overview of ICD-10-CM
      2. Key Features
      3. Organization of the Codebook
      4. Index of 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 MIDTERM
       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
   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
3. Final

Medical billers and coders are responsible for processing patient data, including medical records and related insurance. They code a patient's diagnosis and request payment from the patient's insurance company. Medical billers and coders play an important role in ensuring that healthcare providers are quickly and accurately paid for the treatment they give patients.

Medical billers and coders work in a variety of settings. The most common settings include hospitals and doctors' offices. Some medical billing and coding professionals may work for nursing care facilities, companies that provide administrative and support services, and companies that offer professional, scientific, and technical services.²

Medical billers and coders typically do the following:²

• Review patients’ records for timeliness, completeness, accuracy, and appropriateness of data
• Organize and maintain data for clinical databases and registries
• Track patient outcomes for quality assessment
• Use classification software to assign clinical codes for insurance reimbursement and data analysis
• Electronically record data for collection, storage, analysis, retrieval, and reporting
• Maintain confidentiality of patients’ records
• Review patient information for preexisting conditions so patient data can be coded properly
• Assign appropriate diagnoses and procedure codes for patient care, population health statistics, and billing purposes
• Work as a liaison between the healthcare providers and billing offices

Our Medical Billing and Coding preparation course is self-paced and can be completed in 12 months or less. After successfully completing the course, you will have the option to prepare and sit for one of the following national certifications: (1) NHA's Certified Billing and Coding Specialist (CBCS), (2) AAPC's Certified Professional Coder (CPC^®) or (3) AHIMA's Certified Coding Associate (CCA^®).

There are different medical billing and coding certifications offered through certifying bodies, so it is important to choose which one is right for you. The Certified Professional Coder (CPC®) certification, offered by the American Academy of Professional Coders (AAPC), demonstrates a broad knowledge of medical coding techniques, including assigning diagnosis, procedure, and supply codes to cases and services.