1. Introduction to medical billing
  • What is medical billing?
  • Life cycle of medical billing
  • Process of medical billing
  • Coordination of Information
2. Medical billing terminologies
3. Coding related to medical billing
  • ICD-9 (Diagnosis coding)
  • CPT (Procedural coding)
  • HCPCS
  • Modifiers
  • LMRP (local Medical Review Policies)-state to state coding policies
  • Correct Coding Initiatives
4. Introduction to insurance System/companies
  • Insurance system in general.
  • Different companies and their policies
  • Importance of filing accurate information.
5. Introduction to billing forms
  • CMS-1500 (formerly HCFA-1500)
  • UB-04
  • Patient registration forms (PRF)/Insurance Cards
  • Superbills/Encounter Form
    • a. Office bills
    b. Hospital bills
    c. Nursing home bills
  • Explanation of benefits (EOBs)/ERA
    • a. What are EOBs
    b. Paid and unpaid EOBs
6. Payment Posting
7. Follow ups and reviews
8. Legal considerations and CMS
9. Introduction to medical billing software programs and connectivity
  • Web-based applications
  • Client-server arrangement
  • Remote connectivity
  • VPN connectivity
  • Transfer of old data
10. HIPAA applicability to medical billing & coding
  • Security Mechanism
    • a. Administrative Measures
    b. Physical Measures
    c. Technical Measures
  • Electronic Transaction Standards & Codes Sets
    • a. Claims submission done using ASC 837 standard
    b. Eligibility verification done using ASC 270 standard
    c. Follow up (claims status request) done using ASC 276
    d. Payment posting done using ASC 835
    e. Coding done as per ICD 9, CPT, HCPCS, etc. standards
11. National Provider Identifiers (NPIs)