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