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Medical Billing and Coding

George Mason University

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855.520.6806
Career Training Program
Program Code: GES111
Hours: 240
Fees: $1895.00 USD

Outline

Medical Billing and Coding

  1. The Insurance Billing Specialist and Legal Aspects of Insurance Billing
    1. Personal Qualifications
    2. Career Opportunities
    3. Certification
    4. HIPAA
    5. Insurance Fraud and Abuse
  2. Introduction to Health Insurance
    1. Health Insurance Terms
    2. Managed Care
    3. Healthcare Provider Terms
    4. Third-party Reimbursement Methods
  3. ICD-9-CM
    1. Introduction to Coding
    2. Format of ICD-9-CM
    3. ICD-9-CM Coding Guidelines
    4. ICD-9-CM Coding Conventions
    5. Steps for Assigning ICD-9-CM Codes
  4. ICD-10-CM
    1. Overview of ICD-10-CM
    2. Format of ICD-10-CM
    3. ICD-10-CM Coding Guidelines
    4. ICD-10-CM Coding Conventions
    5. Steps for Assigning ICD-10-CM Codes
  5. CPT and HCPCS Level II
    1. Healthcare Common Procedure Coding System
    2. Organization of the CPT Code Book
    3. CPT Coding Conventions
    4. Organization of the HCPCS Level II Code Book
    5. Steps for Assigning CPT and HCPCS Level II Codes
  6. Abstracting Information from Medical Documents
    1. Coding from SOAP Notes
    2. Coding from a Consultation Report
    3. Coding from Operative Reports
    4. Coding from Emergency Room Records
    5. Coding from Procedure Reports
  7. New Patients, Insurance Claims and EOBs
    1. Electronic, Paper and Hybrid Medical Records
    2. Practice Management Software
    3. Patient Portal
    4. Developing an Insurance Claim
    5. New Patient Procedures
    6. Medical Necessity
    7. Explanation of Benefits (EOB)
    8. Collection Practices
  8. Submitting Electronic Claims and CMS 1500
    1. Electronic Data Interchange (EDI)
    2. Electronic Claims Submission
    3. 1500 Claim Form
    4. National Uniform Claim Committee
  9. Blue Cross/Blue Shield
    1. Participating and Nonparticipating Providers
    2. Allowable Fee
    3. Usual, Customary and Reasonable (UCR)
    4. Blue Shield Claims Submission
  10. Medicare
    1. Medicare Parts A, B, C, and D
    2. Participating and Nonparticipating Providers
    3. Advance Beneficiary Notice (ABN)
    4. Supplemental Insurance
    5. NCCI
    6. Medicare Claims Submission
  11. Other Healthcare Programs
    1. Medicaid
    2. TRICARE
    3. CHAMPVA
    4. Workers’ Compensation
    5. Claims Submission

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