Medical Billing and Coding Specialist

630 Hours / Access Length: 12 Months / Delivery: Online, Self-Paced

Course Overview:

With the Medical Billing Career Prep program, you will gain the skills you need to enter one of the fastest-growing fields in allied health as a medical billing specialist. In this program, you will gain hands-on, practical experience working with the main coding manuals in the field, the ICD-10-CM and the CPT. In addition; you will be introduced to ICD-10-CM. You will also master the legal, ethical, and regulatory concepts that are central to this field. Upon completion of this program, you will be ready to begin your career in an entry-level position.   Students will also be prepared to take the Certified Billing and Coding Specialist (CBCS) national certification exam offered by National Healthcareer Association (NHA).

With the Medical Coding program, you will gain the skills you need to enter one of the fastest-growing fields in allied health as a medical coding specialist. In this program, you will gain hands-on, practical experience working with the main coding manuals in the field. In addition you will be introduced to the new ICD-10-CM diagnosis coding system. You will also master the legal, ethical, and regulatory concepts that are central to this field. 

Recommended Prerequisite: Medical Terminology.  If you do not know Medical Terminology, you can purchase our course at an additional cost.

This course prepares the student to take the following certificaton exam:

• National Healthcareer Association (NHA) Certified Billing and Coding Specialist (CBCS).​

Course Outline:

Medical Billing Career Prep Curriculum:

Lesson 1: Role of the Insurance Billing Specialist

In this lesson, you will learn about your new role as an insurance billing specialist, its responsibilities and tasks, career advantages and necessary qualifications.

Lesson 2: Compliance, Privacy, Fraud, and Abuse in Insurance Billing

In this lesson, you will learn about the Health Insurance Portability and Accountability Act (HIPAA), insurance reforms and the HITECH act. You will discuss the differences between fraud, waste, and abuse and describe how regulations pertain to the Insurance Billing Specialist

Lesson 3: Basics of Health Insurance

In this lesson, you will learn about the history and organization of health insurance in the United States and how the Patient Protection and Affordable Care Act will reform healthcare. You will also follow the administrative life-cycle of a physician-based insurance claim from completion to third-party payer processing and payment.

Lesson 4: The Blue Plans, Private Insurance, & Managed Health Care Plans

In this lesson, you will learn about the differences between a traditional indemnity and a managed care plan, including organization, features and payment mechanisms.

Lesson 5: Medicare, Medicaid, & Other State Programs

In this lesson, you will learn about eligibility, benefits and claim submission for Medicare. Participants will also learn about the history, eligibility, benefits, and claims submission for Medicaid and other state programs.

Lesson 6: TRICARE & Veterans Health Care

In this lesson, you will learn about eligibility, benefits, providers and claim submission guidelines for TRICARE and Veteran's Health Care.

Lesson 7: Workers Compensation

In this lesson, you will learn about the differences between workers' compensation and employers liability insurance, eligibility, waiting periods, types of claims, record keeping, and claim submission.

Lesson 8: Disability Income Insurance & Disability Benefit Programs

In this lesson, you will learn about the benefits and exclusions contained in individual and group disability income insurance, eligibility requirements, procedures for claim submissions.

Lesson 9: Medical Documentation & Electronic Health Records

In this lesson, you will lean about the medical record and its transformation into what is known as the electronic health record. You will explain the importance of documentation and how poor documentation makes it difficult for the Insurance Billing Specialist.

Lesson 10: Diagnostic Coding

In this lesson, you will learn how to code diagnoses and the importance of accurate diagnostic coding. You will have hands-on practice with both ICD-9  and ICD-10 coding conventions and demonstrate your ability to abstract medical conditions from the medical record and accurately assign diagnostic codes.

Lesson 11: Procedural Coding

In this lesson, you will learn the purpose and importance of procedural coding. You will have hands-on practice with CPT coding conventions and demonstrate your ability to abstract information from the medical record and accurately assign procedural codes.

Lesson 12: The Paper Claim (CMS-1500)

In this lesson, you will learn when paper claims are to be used. You will compare the differences between clean, pending, rejected, incomplete, and invalid claims and demonstrate the ability to complete the CMS-1500 claim form accurately for federal, state, and private payer insurance contracts using current basic guidelines.

Lesson 13: The Electronic Claim

In this lesson, you will learn the advantages of electronic claim submission, the methods of interactive computer transactions for transmitting insurance claims and the procedures for transmission.

Lesson 14: Receiving Payments & Insurance Problem Solving

In this lesson, you will learn claim management techniques, solutions for denied and rejected claims, and methods to reduce insurance problems and obtain maximum correct payments.

Lesson 15: Collection Strategies

In this lesson, you will learn about the cash flow cycle in the medical office, including how to explain fees and answer patient questions, offer payment options and how to avoid making patients pay for your mistakes and adding expense and causing a delay in payment.

Lesson 16: Ambulatory Surgery Centers

In this lesson, participants will learn about Outpatient hospital care facilities (as often called ambulatory care) and cover various types of services that do not require an overnight hospital stay. Ambulatory surgery centers, known as ASCs, are health care facilities specifically focused on providing same-day surgical care, including diagnostic and preventive procedures and services.

Lesson 17: Hospital Outpatient & Inpatient Billing

In this lesson, you will learn about the differences in medical billing for a hospital vs. a medical office, the flow of the inpatient hospital stay from billing through receipt of payment and the general guidelines for completion of a paper CMS-1450 (UB-04) and transmission of the electronic claim form.

Lesson 18: Seeking a Job and Attaining Professional Advancement

In this lesson, you will learn about the importance of customer-focused service, pathways to certification, how to search for and successfully apply for a job.

Medical Coding Career Prep Curriculum:

Lesson 1: Reimbursement, HIPAA and Compliance

In this lesson, you will learn about third-party reimbursement issues, such as Medicare, the definition of a participating provider, how to locate information in the Federal Register, the RBRVS system, the framework of Medicare Fraud, and the major components of managed health care. Finally, you will have the opportunity to put this information into practice by completing exercises and class activities.

Lesson 2: An Overview of ICD-10-CM

In this lesson, you will learn about t the ICD-10-CM format and the GEMs file, the Alphabetic Index and the Tabular List, and finally, you will have the opportunity to put this information into practice by using the I-9 to I-10 GEMs file and I-10 to I-9 GEMs file to map codes.

Lesson 3: ICD-10-CM Outpatient Coding and Reporting Guidelines

In this lesson, you will learn about ICD-10-CM Outpatient Coding and Reporting Guidelines. You will have the opportunity to put this information into practice by assigning codes to complete exercises and coding reports.

Lesson 4: Using ICD-10-CM

In this lesson, you will learn about ICD-10-CM Official Guidelines for Coding and Reporting, General Coding Guidelines. You will have the opportunity to put this information into practice by assigning codes to complete exercises and coding reports.

Lesson 5: Chapter-Specific Guidelines (ICD-10-CM Chapters 1-10)

In this lesson you will learn how to apply ICD-10-CM Official Guidelines for Coding and Reporting of infectious diseases, neoplasms, endocrine, nutritional, and metabolic diseases, and immunity disorders, diseases of blood and blood-forming organs, mental disorders, diseases of the nervous system and sense organs, diseases of the circulatory system, and diseases of the respiratory system.

Lesson 6: Chapter-Specific Guidelines (ICD-10-CM Chapters 11-14)

In this lesson, you will learn to apply ICD-10-CM Official Guidelines for Coding and Reporting of diseases of the digestive system, diseases of the skin and subcutaneous tissue, disease of the musculoskeletal system and connective tissues.

Lesson 7: Chapter-Specific Guidelines (ICD-10-CM Chapters 15-21)

In this lesson you will learn to apply ICD-10-CM Official Guidelines for Coding and Reporting of diseases of the pregnancy, childbirth, and the puerperium, certain conditions originating in the perinatal period, congenital malformations, deformations, and chromosomal abnormalities, symptoms signs and abnormal clinical and laboratory findings, not elsewhere classified, and injury and poisoning, and certain other consequences of external causes.

Lesson 8: Introduction to CPT and the Level II National Codes (HCPCS)

In this lesson, you will learn about the CPT manual, periodic updates to the manual, and the information that is required to properly code procedures and services. You will be introduced to the CPT manual format and categories of CPT codes, including proper use of modifiers. You will also have an opportunity to practice exercises to gain familiarity with how to locate terms in the CPT index and to identify content in the CPT appendices.

Lesson 9: Modifiers

In this lesson, you will learn about the use of modifiers to indicate delivery of services in nonstandard ways.

Lesson 10: Evaluation and Management (E/M) Services

In this lesson, you will learn about the information required to properly code procedures and services from the Evaluation and Management (E/M) section of the CPT. You will be exposed to the contents of the E/M section as well as the factors and conditions that affect the determination of the level of service. You will also have an opportunity to practice coding E/M services. Finally, you will be introduced to documentation guidelines for E/M services that apply to services delivered under Medicare/Medicaid.

Lesson 11: Anesthesia

In this lesson, you will learn about the methods of sedation and the formula used to determine to code for anesthesia services.

Lesson 12: Surgery Guidelines and General Surgery

In this lesson, you will learn about the Surgery section format, locate the notes and guidelines in the Surgery section, state the use of unlisted procedures, interpret elements of a special report, examine the designation of separate procedures, analyze contents of a surgical package, and determine the contents of the General Subsection.

Lesson 13: Integumentary System

In this lesson, you will learn how to code the procedures and services described in the Surgery Section and Integumentary System subsection of the CPT.

Lesson 14: Musculoskeletal System

In this lesson, you will learn about the Musculoskeletal System, including how the subsection is coded. Additional attention will be paid to fracture types and repair, application of casts and strapping, the General Subheading, and endoscopic procedures. You will have an opportunity to learn about these subdivisions and to practice coding procedures and services categorized in these subdivisions.

Lesson 15: Respiratory System

In this lesson, you will learn about the format of the Respiratory System subsection of the CPT. Special attention will be paid to the surgical procedures coded in this subsection and to procedures coded under additional subheadings of the nose, accessory sinuses, larynx, trachea and bronchi, and lungs and pleura. Students will also have an opportunity to practice coding procedures from the Respiratory System subsection of the CPT.

Lesson 16: Cardiovascular System

In this lesson, you will learn about the coding of procedures affecting the Cardiovascular System. You will cover coding from the Surgery, Medicine, and Radiology sections, as well as the major classes of procedures that apply in each system.

Lesson 17: Hemic, Lymphatic, Mediastinum, and Diaphragm

In this lesson, you will learn about the codes used to report services involving the Hemic and Lymphatic Systems and the Mediastinum and Diaphragm. Subsection formats and subheadings are also discussed. Finally, you will have the opportunity to complete coding exercises that require the student to assign procedural and diagnostic codes.

Lesson 18: Digestive System

In this lesson, you will learn about the codes used to report services associated with the Digestive System. Coding for services involving the digestive system and subsection formats will be discussed. Finally, you will have the opportunity to practice applying the above information by assigning procedural and diagnostic codes for exercises and coding reports.

Lesson 19: Urinary and Male Genital Systems

In this lesson, you will learn about the codes used to report services associated with the Urinary and Male Genital Systems. Coding for services involving the urinary system and male genital system and subsection formats will be discussed. Finally, you will have the opportunity to practice applying the above information by assigning procedural and diagnostic codes for exercises and coding reports.

Lesson 20: Reproductive, Intersex Surgery, Female Genital System, and Maternity Care and Delivery

In this lesson, you will learn about coding procedures of the Reproductive System, Intersex Surgeries, and also those that affect the Female Genital System. Coding practices, critical terms, and services for maternity care and delivery will also be discussed. Furthermore, you will have the opportunity to analyze abortion procedures.

Lesson 21: Endocrine and Nervous Systems

In this lesson, you will learn about the codes used to report services associated with the Endocrine and Nervous systems. Subsection formats and subheadings are also discussed. Finally, you will have the opportunity to complete coding exercises that require you to assign procedural and diagnostic codes.

Lesson 22: Eye, Ocular Adnexa, Auditory, and Operating Microscope

In this lesson, you will learn about codes used to report services associated with the eye, ocular adnexa, auditory, and the operating microscope. Coding for services involving the eye and ocular adnexa and the auditory system is discussed. Finally, you will have the opportunity to complete coding exercises that require the student to assign procedural and diagnostic codes.

Lesson 23: Radiology

In this lesson, you will learn about codes used to report services associated with radiology services. You will be shown radiology terminology, component coding, elements of the global procedure, and appropriate coding of contrast material. Finally, you also will have the opportunity to put this information into practice by assigning codes to complete exercises and coding reports.

Lesson 24: Pathology/Laboratory

In this lesson, you will learn about codes used to report services associated with radiology services. You will be shown radiology terminology, component coding, elements of the global procedure, and appropriate coding of contrast material. Finally, you also will have the opportunity to put this information into practice by assigning codes to complete exercises and coding reports.

Lesson 25: Medicine

In this lesson, you will learn about the codes in the Medicine section of the CPT manual. You will have the opportunity to put this information into practice by completing exercises and coding reports that require the use of codes in the Medicine section.

Lesson 26: Inpatient Coding

In this lesson, you will learn about Inpatient Coding and Reporting while being able to differentiate between inpatient and outpatient coding and will examine the ICD-10-PCS system.

All necessary course materials are included.

Certification(s):

This course prepares the student to take the following certificaton exam:

• National Healthcareer Association (NHA) Certified Billing and Coding Specialist (CBCS).​

• Cable and DSL internet connections are recommended for the best experience.

• CPU: 1 GHz or higher
• RAM: 2 GB or higher
• Resolution: 1280 x 720 or higher
• Speakers / Headphones
• Microphone (Webinar / Live Online sessions)

• Microsoft Windows 7 or 10 (Home, Pro)
• Mac OSX 10 or higher.
• Latest Chrome OS
• Latest Linux Distributions

NOTE: While we understand that our courses can be viewed on Android and iPhone devices, we do not recommend the use of these devices for our courses. The size of these devices do not provide a good learning environment for students taking online or live online based courses.

• Latest Google Chrome is recommended for the best experience.
• Latest Mozilla FireFox
• Latest Microsoft Edge
• Latest Apple Safari

• Office suite software (Microsoft Office, OpenOffice, or LibreOffice)
• PDF reader program (Adobe Reader, FoxIt)
• Courses may require other software that is denoted in the above course outline.