Course Code: GES145
I. Introduction to Medical Billing and Coding
A. Personal Qualifications
B. Career Opportunities
II. Healthcare Law
A. HIPAA Privacy Rule and Security Rule
B. Protected Health Information
C. Fraud and Abuse
D. Stark Law
E. False Claims Act
III. Introduction to Health Insurance Terms
A. Health Insurance Terms
B. Managed Care
C. Healthcare Provider Terms
D. Third-Party Reimbursement Methods
IV. Pharmacology for Coders
A. Definition of Pharmacology
B. Generic and Brand Names
C. Drug Classifications
D. Therapeutic Uses of Medications
E. Routes of Administration
G. Medication Lists
A. Overview of ICD-10-CM
B. Format of ICD-10-CM
C. ICD-10-CM Coding Guidelines
D. ICD-10-CM Coding Conventions
E. Steps for Assigning ICD-10-CM Codes
VI. CPT and HCPCS Level II Coding
A. Healthcare Common Procedure Coding System
B. Organization of the CPT Code Book
C. CPT Coding Conventions
D. Organization of the HCPCS Level II Code Book
E. Steps for Assigning CPT and HCPCS Level II Codes
VII. Abstracting Information from Medical Documents
A. Coding from SOAP Notes
B. Coding from a Consultation Report
C. Coding from Operative Reports
D. Coding from Emergency Room Records
E. Coding from Procedure Reports
VIII. New Patients, Insurance Claims and EOBs
A. Electronic, Paper and Hybrid Medical Records
B. Practice Management Software
C. Patient Portal
D. Developing an Insurance Claim
E. New Patient Procedures
F. Medical Necessity
G. Explanation of Benefits (EOB)
H. Collection Practices
IX. Submitting Electronic Claims and CMS 1500
A. Electronic Data Interchange (EDI)
B. Electronic Claims Submission
C. 1500 Claim Form
D. National Uniform Claim Committee
X. Blue Cross/Blue Shield
A. Participating and Nonparticipating Providers
B. Allowable Fee
C. Usual, Customary and Reasonable (UCR)
D. Blue Shield Claims Submission
A. Medicare Parts A, B, C and D
B. Participating and Nonparticipating Providers
C. Advance Beneficiary Notice (ABN)
D. Supplemental Insurance
F. Medicare Claims Submission
XII. Other Healthcare Programs
D. Workers’ Compensation
E. Claims Submission
XIII. ICD-10-PCS (Optional Lesson)
A. Overview of ICD-10-PCS
B. ICD-10-PCS Code Structure
C. Index and Table Conventions
D. Code Components
E. Definitions Used in ICD-10-PCS
XIV. Survey of Hospital Billing
A. Hospital Revenue Cycle
C. Master Patient Index
D. Prospective Payment Systems
E. Principal Diagnosis
F. Present On Admission
XV. Career Roadmap for Medical Billing and Coding – Find a Job Fast
B. Succeeding in the Gig Economy
C. Your Skills and Talents
D. Your Résumé and Cover Letter
E. Using Email and Social Media
F. Connecting with Others
G. Acing the Interview
H. Negotiating Your Salary
I. After You Land the Job
J. Review and Reflect
I. A Foundation in Medical Terminology
A. The Fundamentals of Medical Terminology
B. Overview of the Human Body
C. Practicing What You’ve Learned
II. The Skeletal and Muscular Systems
A. Overview of the Skeletal System
B. Overview of the Muscular System
C. Practicing What You’ve Learned
III. The Cardiovascular and Respiratory Systems
A. Overview of the Cardiovascular System
B. Overview of the Respiratory System
C. Practicing What You’ve Learned
IV. The Digestive, Urinary, and Reproductive Systems
A. Overview of the Digestive System
B. Overview of the Urinary System
C. Overview of the Reproductive System
D. Practicing What You’ve Learned
V. Nervous and Integumentary Systems and Special Senses
A. Overview of the Nervous System
B. Overview of the Integumentary System
C. Overview of Special Senses
D. Practicing What You’ve Learned
VI. The Lymphatic, Immune, and Endocrine Systems
A. Overview of the Lymphatic System
B. Overview of the Immune System
C. Overview of the Endocrine System
D. Practicing What You’ve Learned
Nancy Smith has almost 30 years of experience in healthcare education. After graduating from college with a degree in vocational education, she taught administrative medical programs in vocational schools and community colleges. In addition, she has professional experience as a medical coder, insurance claims specialist, medical records auditor, and medical office manager. She is a member of AHIMA and has a CCS-P coding certification. She currently does coding for ambulatory surgery center and resides in Pittsburgh, Pennsylvania.
LaTisha Cottingham has over 20 years of experience in the healthcare industry. She has six years of teaching experience in the field of medical billing and coding and Medical Assisting. Currently she is employed as an HIM Analyst for a Long-Term Care establishment that is based out of Alabama. Previously she was employed as the lead instructor for the Allied Health Department for a local career institute. LaTisha's field of expertise is in the area of physician-based inpatient coding and Emergency Department coding. The certifications that she holds are as follows: a Registered Health Information Technician (RHIT), a Certified Professional Coder (CPC), and a Certified Clinical Medical Assistant (CCMA). In preparation for ICD-10-CM, LaTisha received her ICD-10-CM/PCS Trainer Certification from American Health Information Association (AHIMA), where she is currently a member. LaTisha is also a member of the American Academy of Professional Coders (AAPC) and the National Healthcare Association (NHA) where she is a test proctor.
Carline Dalgleish has worked in medical office administration for over 30 years. She holds a bachelor’s degree in Business Information Systems, a master’s degree in Leadership, and a post-baccalaureate certificate in Health Information Management. She is a Registered Health Information Administrator and an AHIMA Approved ICD-10-CM/PCS Trainer. Dalgleish is the author of an ICD-10 coding system and also owns her own consulting firm, AnnGrant Educational Services.
LaTrisha Howard has over 10 years experience in the healthcare industry. LaTrisha has expertise in coding Inpatient, Outpatient, and ER medical records. In addition to Ms. Howard’s experience in coding, she has experience in chart auditing and physician education. She is currently working as an ER Coder/Auditor for a physician billing and consulting service, and currently holds the CCS and CPC certification, as well as being a member of AHIMA and AAPC.
Shonda Miles is a Certified Professional Coder, Certified Professional Medical Auditor, and holds an Executive Masters of Business Administration, Master’s Degree in Business Administration with a concentration in Human Resources and a Bachelor’s degree in Business Administration (Management). Shonda Miles has over 6 years in the healthcare industry. Shonda has expertise in coding and chart auditing Inpatient, Outpatient, and ER medical records. She is a member of AAPC, NAMAS and ACHE. She is currently employed with a university hospital as a Compliance Auditor. She resides in Shreveport, LA.
Lydia S. Stewart, RN, BSN, currently serves as the Revenue Cycle Manager at a large regional medical center. Lydia has been a Registered Nurse for 23 years, 15 of those years specializing in Critical Care Nursing and supervision. She is responsible for Medical Audits, Charge Capture, and governmental compliance audits and reviews. Lydia is a member of the Louisiana Medical Auditor Association and Healthcare Financial Management Association (HFMA).
Bunny Reeves is the senior ambulatory surgery coder at the Maimonides Medical Center in Brooklyn, New York. She trains student coders at Maimonides Medical Center and previously trained and supervised entry-level coders at Staten Island’s St. Vincent Medical Center. Reeves is a Certified Coding Specialist, accredited by the American Health Information Management Association (AHIMA).
Sharon L. Blackford, MA, BA, RMA, has over 30 years of experience in the medical field. She has a Master’s degree in Organizational Management, a Bachelor’s degree in Business Management, and has served as a Registered Medical Assistant since 1994. Sharon was an active duty Clinical Specialist in the U.S. Army for 10 years. Sharon later moved to the Gulf Coast to accept a position as the Director of Education of Blue Cliff College and was promoted to Campus Director.
There are no prerequisites to take this course.
The instructional materials required for this course are included in enrollment. The following textbooks will be shipped to you approximately 7-10 business days after enrollment:
After successfully completing your course, you’ll also receive access to the American Academy of Professional Coders (AAPC) online CPC Exam Review course, to help you study for your certification exam.
The American Academy of Professional Coders (AAPC) is one of the world’s most recognized institutions for professional medical coders, with more than 175,000 members. The AAPC offers more than 30 certifications that include medical billing and coding, compliance, and management, among other topics. These certifications are an excellent way to prove you have a working knowledge of specific aspects of healthcare, and the skills you need to practice in the field. All AAPC certifications share a common goal: help everyone from beginners to experienced professionals advance their careers and contribute positively to the industry.
Yes, ed2go courses are completely online. However, keep in mind that not all certifying bodies or industry-specific certifications are recognized internationally. Please review your country’s regulations prior to enrolling in courses that prepare for certification.
Yes! This course prepares you to sit for the Certified Professional Coder (CPC) exam, offered by the American Academy of Professional Coders (AAPC). You will receive a voucher for the exam after successfully completing the course and your financial obligation.
This course is open enrollment, so you can register and start the course as soon as you are ready. Access to your course can take 24-48 business hours.
This course is self-paced and open enrollment, so you can start when you want and finish at your own pace. When you register, you'll receive twelve (12) months to complete the course.
The time allotted for course completion has been calculated based on the number of course hours. However, if you are unable to complete the course, contact your Student Advisor to help you work out a suitable completion date. Please note that an extension fee may be charged.
You may be assigned with an instructor or team of industry experts for one-on-one course interaction. Your support will be available (via e-mail) to answer any questions you may have and to provide feedback on your performance. All of our instructors are successful working professionals in the fields in which they teach. You will be assigned to an Advisor for academic support.
Upon successful completion of the course, you will be awarded a certificate of completion. In addition, you will receive an exam voucher for the Certified Professional Coder (CPC) exam, offered by the American Academy of Professional Coders (AAPC) after successful completion of the course and financial obligation.
This course will provide you with the skills you need to obtain an entry-level position in most cases. Potential students should always do research on the job market in their area before registering.
ed2go courses are non-credit, so they do not qualify for federal aid, FAFSA and Pell Grant. In some states, vocational rehab or workforce development boards will pay for qualified students to take our courses. Additionally, some students may qualify for financial assistance when they enroll, if they meet certain requirements. Financing is available from select schools. Learn more: https://www.ed2go.com/career/financial-assistance
If you have questions that are not answered on our website, representatives are available via LIVE chat. You can also call us at 1-877-221-5151 during regular business hours to have your questions promptly answered. If you are visiting us during non-business hours, please send us a question using the “Contact Us” form.
CPC stands for Certified Professional Coder, and it’s the most highly recognized medical coding certification in the healthcare industry. The credential is offered by the American Academy of Professional Coders (AAPC). Earning your CPC credential will show prospective employers that you’ve mastered various types of codes including CPT, ICD-10-M, and HCPCS Level II. It will also show that you understand how to review physician and non-physician provider documentation, code for surgical procedures, and adhere to regulatory coding guidelines.
Yes. There is a high demand for qualified medical billing and coding professionals in the healthcare industry today. Demand will increase as the population in the Unites States ages. Jobs for these professionals are on the rise and expected to grow faster than average through 2026 according to the Bureau of Labor Statistics.
Medical Billers and Coders are responsible for processing patient data including medical records and related insurance. In this position, you will code a patient’s diagnosis and then request payment from the patient’s insurance company. You will play an important role in ensuring that healthcare providers are quickly and accurately paid for the treatment they give patients.
Medical Billers and Coders work in a variety of settings. The most common settings include hospitals, doctors’ offices and insurance agencies. Some medical billing and coding professionals work for companies that develop medical software, and some work for education institutions that work to train other medical billers and coders. Government agencies have also been known to employ medial billers and coders including the National Center for Health Statistics and Medicaid offices. You may also have the ability to work for a reputable company from your own home!
A day in the life of a Medical Biller and Coder is a rewarding one. You are responsible for ensuring that healthcare providers receive appropriate compensation for the care they provide as well as helping patients get the maximum benefit of their insurance. It is a job that requires a high level of attention to detail at all times because codes must be correct to produce appropriate bills for services. Much of your time will be spent in front of a computer organizing statements, reviewing bills, and performing quality control. You also may be required to negotiate with insurance companies via phone on behalf of providers or patients. It’s also important to coordinate with other coders to ensure accuracy and adherence to standards. Finally, you’ll want to keep up on the latest developments and regulations in the industry through continuing education.
According to the AAPC based on its membership, the average Medical Biller and Coder without certification earns around $45,000 per year while those with certification earn an average of $51,500. This means that certification can help you earn up to 15 percent more in this field! Other salary websites place the median salary for those starting out in Medical Billing and Coding around $38,500.
The CPC exam is a multiple-choice test. It is made up of 150 multiple-choice questions and you will have up to 5 hours and 40 minutes to finish the exam. You can and will use your codebooks to take the exam. You will be required to correctly answer 105 questions (70 percent) to pass the exam.
Other than a handful of exceptions, medical billing and medical coding are two separate professions. You do not need a degree for either profession, but successful coders usually obtain certification. This course will fully prepare you for a career as either a medical biller or a medical coder, including recommended certification. Once you’ve completed your training, you will decide which area fits your personality and career goals best and move in that direction.
Medical billers are mainly responsible for submitting patient records to government agencies and insurance companies for services that have been provided in the care of the patient. Medical coders gather information on patient records and assign the proper codes for patient diagnosis which are then used by medical billers to submit claim forms.
Due to the more technical nature of the job and increased training required, medical coders do tend to make more than medical billers on an annual basis. Both medical billers and medical coders are in high demand. Medical billers earn a median salary of nearly $37,000. The salary of medical coder depends on a variety of different factors including certifications, specialties and experience, but the American Academy of Professional Coders (AAPC) reports that their average salary is around $47,800.