100 Hours Synchronous Learning / 60 Hours Online Learning3
Medical Billing and Coding Career Prep Complete is a growing career field with numerous job opportunities. This course combines the basics of medical coding, medical billing, and medical terminology to provide a comprehensive program that will prepare you to work as a Medical Coding and Billing Specialist in a professional medical office. In this course, you will learn about the necessary medical terminology, insurance guidelines and compliance requirements, medical billing functions, and legal and ethical issues. Upon completion of this course, you will be fully prepared to begin working in a professional medical office. Students will be prepared to take the NHA Billing and Coding Specialist Certification (CBCS) national certification exam.
Recommended Prerequisites: High School Graduate or GED holder
Students will be prepared to take the NHA Billing and Coding Specialist Certification (CBCS) national certification exam.
- Describe the role of the Certified Medical Billing Specialist
- Describe the origin of medical language.
- Analyze the component parts of a medical term.
- List and define basic prefixes, suffixes, and combining forms.
- Use basic prefixes, suffixes, and combining forms to build medical terms.
- Explain common rules for proper medical term formation, pronunciation, and spelling.
- Assess the responsibilities assigned to insurance billing and coding specialists and electronic claims processors.
- Describe the health care delivery system.
- Explain the responsibilities of the billing and coding specialist to protect patient rights under HIPAA.
- Demonstrate a basic understanding of the anatomy and physiology of body systems and related medical terminology in order to properly process clean claims.
- Utilize the ICD‐9-CM manual, including V codes, E codes, and the Neoplasm and Hypertension tables.
- Demonstrate a basic understanding of the ICD-10-CM and ICD-10-PCS
- Utilize the CPT manual and the various guidelines.
- Demonstrate diagnostic and procedural coding.
- Describe basic guidelines for submitting insurance claims.
- Explain the difference between clean, pending, rejected, incomplete, and invalid claims.
- Identify solutions for denied and rejected paper and electronic claims.
- Identify when a paper claim can and cannot be used.
- Explain the relationship of transactions and security with electronic data.
- Communicate (verbally and non‐verbally) effectively and appropriately in the workplace
- Role of an Insurance Billing Specialist
- Privacy, Security, and HIPAA
- Compliance, Fraud, and Abuse
- Basics of Health Insurance & The Blue Plans, Private Insurance, and Managed Care Plans
- Medicaid and Other State Programs & TRICARE and Veterans Health Care
- Workers Compensation
- Disability Income Insurance and Disability Benefit Programs & Medical Documentation and the Electronic Health Record
- Diagnostic Coding
- Procedural Coding & The Paper Claim CMS-1500
- The Electronic Claim
- Receiving Payments and Insurance Problem Solving & Collection Strategies
- Ambulatory Surgery Center
- Hospital Outpatient and Inpatient Billing & Seeking a Job and Attaining Professional Advancement
- Reimbursement, HIPAA, and Compliance
- An Overview of ICD-10-CM
- ICD-10-CM Outpatient Coding and Reporting Guidelines & Using ICD-10-CM
- Specific Guidelines (ICD-10-CM Chapters 1-10)
- Specific Guidelines (ICD-10-CM Chapters 11-14)
- Chapter-Specific Guidelines (ICD-10-CM Chapters 15-21)
- Introduction to CPT
- Introduction to the Level II National Codes (HCPCS) & Modifiers
- Evaluation and Management EM Services & Anesthesia
- Surgery Guidelines and General Surgery & Integumentary System
- Musculoskeletal & Respiratory System
- Cardiovascular System & Hemic, Lymphatic, Mediastinum, and Diaphragm
- Digestive System & Urinary and Male Genital Systems
- Reproductive, Intersex Surgery, Female Genital System, Maternity Care and Delivery &Endocrine and Nervous Systems
- Eye, Ocular Adnexa, Auditory, and Operating Microscope & Radiology
- Pathology Laboratory & Medicine
- Inpatient Coding
- Final Exam
“From the first phone call, I knew ProTrain was the school for me. Soon I will be sitting at the certification test, and I know I will pass! Our instructor went out of her way to make sure we learned what we needed to be ready for our new career and prepare us for the exam. Now I have the confidence and knowledge to enter this field, thank you for making it possible to follow my dreams and succeed!”
- Skills Demonstration
- Group Activities
- Individual Activities
Methods of Evaluation:
- Written Assignments
- Skills Demonstration
Student must pass all quizzes, exams, and national exam (if applicable) at a passing rate to be eligible for a Certificate of Training Completion. If an internship is included in your course you will be required to complete the internship prior to receiving a Certificate of Training Completion.
Students are expected to arrive on time and participate in course discussions. Successful completion of the course of study recommends 100% attendance. If during the course period the student’s attendance level drops below 80%, they will be encouraged and given the opportunity to attend the next scheduled class for the course they enrolled in. Should materials change, student is responsible for all additional cost.
Payment Plan Policy:
Students may withdraw from the program for any reason up to 1 week prior to the start of program. In this case, the student’s payment plan agreement shall be rescinded. If the payment plan has begun a non-refundable administrative fee of $25.00 will be assessed and remaining funds will be returned to payer in check form by mail.
There can be no refund for the course, once the first class has been concluded; or if any course material, including the eBook, is accessed. If extenuating circumstances exist, case by case situations will be reviewed by ProTrain. If a refund is issued, the refunded amount (- a $25 processing fee) will be dependent upon books being returned in excellent condition (i.e. no writing, missing pages; ripped or damage to pages and/or binding).
Any student who has dropped out of the program, or has been suspended from the program for nonattendance may be readmitted within one year by completing a personal interview with the director of education and paying any applicable fees at the time of readmission. Students who were terminated due to conduct issues are not eligible to be readmitted.
Policy on Student Conduct:
Appropriate Conduct: All students are expected to conduct themselves in an orderly and professional manner. Any student not conducting themselves in an orderly and professional manner, which includes use of drugs and alcohol during school hours, dishonesty, disrupting classes, use of profanity, excessive tardiness, insubordination, violation of safety rules, improper usage of lab or classroom computers, or not abiding by the school rules will lead to either probation or dismissal from classes.