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Administrative Medical Specialist with Medical Billing and Coding

Union County College

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855.520.6806
Career Training Program
Program Code: GES102
Hours: 300
Fees: $1995.00 USD

Outline

Administrative Medical Specialist

  1. The Medical Assisting Profession and the Healthcare Team
    1. Career Opportunities
    2. Certification
    3. Scope of practice
    4. Ambulatory Healthcare Settings
    5. The Healthcare Team
  2. Coping Skills and Therapeutic Communication
    1. Stress and Burnout
    2. Types of Communication
    3. Barriers to Effective Communication
    4. Interview Techniques
    5. The Stages of Grief
  3. Legal and Ethical Consideration
    1. Administrative Laws
    2. Health Insurance Portability and Accountability Act (HIPAA)
    3. Informed Consent
    4. Advance Directives
    5. Ethical Guidelines for Healthcare Providers
  4. The Facility Environment
    1. The Reception Area
    2. The Medical Receptionist
    3. Legal Compliance Issues
    4. Safety Issues
    5. Opening and Closing the Facility
  5. Computers in the Ambulatory Care Setting and Telecommunications
    1. Use of Computers in the Medical Office
    2. Electronic Medical Record (EMR) and Electronic Health Record (EHR)
    3. Safeguarding protected health information (PHI)
    4. Telephone Techniques
    5. Faxing, Email and the Patient Portal
  6. Patient Scheduling
    1. Patient Scheduling
    2. Scheduling Methods
    3. Cancellations and No Shows
  7. Medical Records Management
    1. Importance of Medical Records
    2. Electronic, Paper and Hybrid Medical Records
    3. Arrangement of the Medical Record
    4. Filing Systems
    5. Basic Rules for Filing
  8. Written Communications
    1. Composing a Business Letter
    2. Proofreading
    3. Components of a Business Letter
    4. Meeting Agendas
  9. Medical Documents
    1. Progress Notes
    2. History and Physicals
    3. Operative Reports
    4. Consultations
    5. Discharge Summaries
    6. Radiology and Imaging Reports
    7. Pathology Reports
    8. Procedure Reports
    9. Electronic Signatures
  10. Daily Financial Practices
    1. Patient Fees and Adjustments
    2. Managing Patient Accounts
    3. Accounts Payable and Accounts Receivable
    4. Petty Cash and the Cash Drawer
    5. Banking

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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