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