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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

  1. Insurance Claim Processing
  2. Claim Payment
  3. Report Generation

Understanding Office Forms

  1. Essential Office Forms
    • Patient Demographic Form and Completion
    • Insurance Cards
    • Insurance Verification Form and Verification Procedures
    • Superbill
    • Daysheet
  2. Examining Insurance Cards
  3. Insurance Verification Process
  4. Mock Insurance Verification Conversations
  5. Insurance Verification Exercises

The Superbill/Encounter Document

Calculating Co-paymentss & Deductibles

Understanding the CMS 1500 Form

  1. The Basics of the CMS 1500 Form
  2. Box by Box Breakdown of the CMS 1500 Form
  3. Step-By-Step Instructions for Completing a CMS 1500
  4. Online CMS Form Completion Exercises
  5. Billing Tips
  6. Commonly Made Errors

Understanding Codes

  1. Definition
  2. Proper Usage
  3. Resource & Reference Material

ICD (International Classification of Disease) Coding

  1. Definition
  2. Proper Usage
  3. Resource & Reference Material

The Life Cycle of an Insurance Claim

The Time-Line of an Insurance Claim
The Collection of Claim Data

  1. Patient Demographics
  2. Guarantor Information & Handling
  3. Insurance Coverage Information
  4. Patient Condition Information
  5. Patient Treatment Information
  6. Clinic Billing Information

Claim Information Data Entry
Claim Submission

  1. Paper Claims
  2. Electronic Claims
  3. Secondary Claims
  4. Claims Attachments

Receiving & Posting Payments

  1. Full Payment
  2. Partial Payment
  3. Deductible

Working with Billing/Practice Management Software

Basic Components of Billing Applications Clinic Data

  • Billing Identification Numbers

Physician Data

  1. Tax ID, UPIN, License Numbers
  2. Assignment

Patient Data

  1. Demographics Information
  2. Insurance Information
  3. Procedure Information
  4. Diagnosis Information

Claim Generation

  1. Charge Entry
  2. Payment Entry
  3. Financial Adjustments
  4. Transaction Notes

Electronic & Paper Claims

Calculating Co-paymentss & Deductibles

100 Co-payments & Deductibles Problems & Answers

Chapter AC3: Understanding Workers’ Compensation

Introduction to Workers Compensation

  1. Medical Claims
  2. Temporary Disability
  3. Permanent Disability
  4. Vocational Rehabilitation
  5. 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

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