Medical Billing Syllabus
Introduction to Medical Billing
About Medical Billing
The Basics Overview
- Gathering & Entering Data
- Paper Claims Processing
- Electronic Claims Processing
- Posting Payments
- Generating Reports
- Billing Your Clients
Types of Insurance Coverage
- Group Health
- Individual Policies
- Medicare
- Medicaid
- Personal Injury (PIP)
- Workers Compensation
- Tricare
Procedures and Diagnoses
Insurance Claim Processing
Claim Payment
Report Generation
Understanding Office Forms
Essential Office Forms
- Patient Demographic Form and Completion
- Insurance Cards
- Insurance Verification Form and Verification Procedures
- Superbill
- Daysheet
Examining Insurance Cards
Insurance Verification Process
Mock Insurance Verification Conversations
Insurance Verification Exercises
The Superbill/Encounter Document
Calculating Copayments & Deductibles
Understanding the CMS 1500 Form
The Basics of the CMS 1500 Form
Box by Box Breakdown of the CMS 1500 Form
Step-By-Step Instructions for Completing a CMS 1500
Online CMS Form Completion Exercises
Billing Tips
Commonly Made Errors
Understanding Codes
CPT (Current Procedural Technology) Coding
- Definition
- Proper Usage
- Resource & Reference Material
ICD (International Classification of Disease) Coding
- Definition
- Proper Usage
- Resource & Reference Material
The Life Cycle of an Insurance Claim
The Time-Line of an Insurance Claim
The Collection of Claim Data
- Patient Demographics
- Guarantor Information & Handling
- Insurance Coverage Information
- Patient Condition Information
- Patient Treatment Information
- Clinic Billing Information
Claim Information Data Entry
Claim Submission
- Paper Claims
- Electronic Claims
- Secondary Claims
- Claims Attachments
Receiving & Posting Payments
- Full Payment
- Partial Payment
- Deductible
Working with Billing/Practice Management Software
Basic Components of Billing Applications
Clinic Data
- Billing Identification Numbers
Physician Data
- Tax ID, UPIN, License Numbers
- Assignment
Patient Data
- Demographics Information
- Insurance Information
- Procedure Information
- Diagnosis Information
Claim Generation
- Charge Entry
- Payment Entry
- Financial Adjustments
- Transaction Notes
Electronic & Paper Claims
Calculating Copayments & Deductibles
100 Copayment & Deductibles Problems & Answers
Chapter AC3: Understanding Workers' Compensation
Introduction to Workers Compensation
- Medical Claims
- Temporary Disability
- Permanent Disability
- Vocational Rehabilitation
- Survivor Benefits
Federal Workers Compensation Overview & Claim Filing
State Workers Compensation Overview & Claim Filing
First Report of Injury
CMS 1500 Completion for Workers Compensation Claims
- Box by Box Instruction
Appeals & Adjudication
Fraud & Abuse
Tips for Successful Workers Compensation Claim Filing & Handling
FINAL EXAMINATION and CERTIFICATE
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