With the Medical Billing Career Prep program, you will gain the skills you need to enter one of the fastest-growing fields in allied health as a medical billing specialist. In this program, you will gain hands-on, practical experience working with the main coding manuals in the field, the ICD-10-CM and the CPT. In addition; you will be introduced to ICD-10-CM. You will also master the legal, ethical, and regulatory concepts that are central to this field. Upon completion of this program, you will be ready to begin your career in an entry-level position.   Students will also be prepared to take the Certified Billing and Coding Specialist (CBCS) national certification exam offered by National Healthcareer Association (NHA).

The content in the certification course will prepare students to take the associated industry recognized exam.  Please note that the individual state requirements may vary.  Students will be responsible to check with their state’s governing body for state specific requirements.

Students will:

• 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‐10-CM manual, including V codes, Z codes, and the Neoplasm and Hypertension tables.
• Utilize the CPT manual and the various guidelines.
• Utilize the ICD-10-CM coding system.
• 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.
• State 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.

This course prepares the student to take the following certificaton exam:

• National Healthcareer Association (NHA) Certified Billing and Coding Specialist (CBCS).​

Course Outline:

Lesson 1: Role of the Insurance Billing Specialist

In this lesson, you will learn about your new role as an insurance billing specialist, its responsibilities and tasks, career advantages and necessary qualifications.

Lesson 2: Compliance, Privacy, Fraud, and Abuse in Insurance Billing

In this lesson, you will learn about the Health Insurance Portability and Accountability Act (HIPAA), insurance reforms and the HITECH act. You will discuss the differences between fraud, waste, and abuse and describe how regulations pertain to the Insurance Billing Specialist

Lesson 3: Basics of Health Insurance

In this lesson, you will learn about the history and organization of health insurance in the United States and how the Patient Protection and Affordable Care Act will reform healthcare. You will also follow the administrative life-cycle of a physician-based insurance claim from completion to third-party payer processing and payment.

Lesson 4: The Blue Plans, Private Insurance, & Managed Health Care Plans

In this lesson, you will learn about the differences between a traditional indemnity and a managed care plan, including organization, features and payment mechanisms.

Lesson 5: Medicare, Medicaid, & Other State Programs

In this lesson, you will learn about eligibility, benefits and claim submission for Medicare. Participants will also learn about the history, eligibility, benefits, and claims submission for Medicaid and other state programs.

Lesson 6: TRICARE & Veterans Health Care

In this lesson, you will learn about eligibility, benefits, providers and claim submission guidelines for TRICARE and Veteran’s Health Care.

Lesson 7: Workers Compensation

In this lesson, you will learn about the differences between workers’ compensation and employers liability insurance, eligibility, waiting periods, types of claims, record keeping, and claim submission.

Lesson 8: Disability Income Insurance & Disability Benefit Programs

In this lesson, you will learn about the benefits and exclusions contained in individual and group disability income insurance, eligibility requirements, procedures for claim submissions.

Lesson 9: Medical Documentation & Electronic Health Records

In this lesson, you will lean about the medical record and its transformation into what is known as the electronic health record. You will explain the importance of documentation and how poor documentation makes it difficult for the Insurance Billing Specialist.

Lesson 10: Diagnostic Coding

In this lesson, you will learn how to code diagnoses and the importance of accurate diagnostic coding. You will have hands-on practice with both ICD-9  and ICD-10 coding conventions and demonstrate your ability to abstract medical conditions from the medical record and accurately assign diagnostic codes.

Lesson 11: Procedural Coding

In this lesson, you will learn the purpose and importance of procedural coding. You will have hands-on practice with CPT coding conventions and demonstrate your ability to abstract information from the medical record and accurately assign procedural codes.

Lesson 12: The Paper Claim (CMS-1500)

In this lesson, you will learn when paper claims are to be used. You will compare the differences between clean, pending, rejected, incomplete, and invalid claims and demonstrate the ability to complete the CMS-1500 claim form accurately for federal, state, and private payer insurance contracts using current basic guidelines.

Lesson 13: The Electronic Claim

In this lesson, you will learn the advantages of electronic claim submission, the methods of interactive computer transactions for transmitting insurance claims and the procedures for transmission.

Lesson 14: Receiving Payments & Insurance Problem Solving

In this lesson, you will learn claim management techniques, solutions for denied and rejected claims, and methods to reduce insurance problems and obtain maximum correct payments.

Lesson 15: Collection Strategies

In this lesson, you will learn about the cash flow cycle in the medical office, including how to explain fees and answer patient questions, offer payment options and how to avoid making patients pay for your mistakes and adding expense and causing a delay in payment.

Lesson 16: Ambulatory Surgery Centers

In this lesson, participants will learn about Outpatient hospital care facilities (as often called ambulatory care) and cover various types of services that do not require an overnight hospital stay. Ambulatory surgery centers, known as ASCs, are health care facilities specifically focused on providing same-day surgical care, including diagnostic and preventive procedures and services.

Lesson 17: Hospital Outpatient & Inpatient Billing

In this lesson, you will learn about the differences in medical billing for a hospital vs. a medical office, the flow of the inpatient hospital stay from billing through receipt of payment and the general guidelines for completion of a paper CMS-1450 (UB-04) and transmission of the electronic claim form.

Lesson 18: Seeking a Job and Attaining Professional Advancement

In this lesson, you will learn about the importance of customer-focused service, pathways to certification, how to search for and successfully apply for a job.

All necessary course materials are included.

Certification(s):

This course prepares the student to take the following certificaton exam(s):

• National Healthcareer Association (NHA) Certified Billing and Coding Specialist (CBCS).​