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Medical Billing Syllabus

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 Co-paymentss & 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

  • 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 Co-paymentss & Deductibles

100 Co-payments & 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

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