Medical Coding/Billing and Terminology
680 Hours/12 Months/Instructor Supported
Course Overview:
Our Medical Coding course is a practical and relevant guide for the modern health care environment. It provides an overview of CPT and ICD-9-CM coding, and addresses coding issues within specific coding content areas. This course takes you through all steps necessary to code a claim correctly, link the correct codes for reimbursement for insurance carriers and government entities, and explains adjustments and how and when to bill patients. It even provides information on what to do if there is a denial or rejection.
Medical Coding is listed as one of the fastest growing professions in allied health. The medical industry is experiencing a tremendous demand for individuals with knowledge of medical office operations, which includes diagnostic and procedural coding.
Upon successful completion of our Medical Coding course, students will be prepared for an entry-level position doing medical coding in a medical office setting and will be prepared to sit for the AHIMA national certification exam to become a Certified Coding Associate (CCA).
The Professional Review Guidebook included with this course will assist you in preparing for the AHIMA CCA Examination. You will practice interpreting documentation and applying your knowledge in assigning codes to diagnoses and procedures for a variety of patient settings. We offer interactive mock examination for real-world test taking practice.
Prerequisite: Solid knowledge of Medical Terminology. If you do know Medical Terminology you can take our course bundle with Medical Coding + Medical Terminology.
The ICD-9 is currently being used in the U.S. workplace and is scheduled to be changed October 1, 2014 to the ICD-10. Canada and Europe are currently using the ICD-10 and the ICD-11 is in the initial research phase. There is some consideration in the U.S. that we should skip the ICD-10 and move directly to the ICD-11 but this is just a preliminary discussion. Right now what we know is that all students MUST learn the ICD-9 to pass the certification exams and work in the U.S. By learning about the ICD-10 you will be ready for whatever transition is to come since the ICD-11 will be based on the ICD-10.
Here are the important points to remember:
- Between now and January 2014, the student should have a working knowledge of ICD-9 and a basic knowledge of the ICD-10.
- After January 2014, the student should have a working knowledge of both ICD-9 and ICD-10.
- Employers want graduates to have ICD-9 knowledge from January to October, 2014, because transactions will be ICD-9 based until October 1, 2014, when transactions will begin to be ICD-10 based.
- Even if the U.S. skips the ICD-10 and goes straight to the ICD-11 students that already know the ICD-10 will have a great advantage over those that do not.
Course Outline:
Medical Coding Module 1
Medical Terminology
- Pronunciation
- Spelling
- Word Roots
- Combining Vowels/Form
- Prefixes
- Suffixes
- General Rules
- Word Building
- Abbreviations
- Procedural and Diagnostic Billing Codes
- Body Structure
- Organization of the Body
- Anatomical Position
- Body Planes
- Directional and Positional Terms
Advanced Medical Coding Module 2
Introduction to Coding
- A Career as a Medical Coder
- Types of Coding
- ICD-9-CM
- V Codes and E Codes
- M Codes
- Categories, Subcategories, and Subclassifications
- Procedural Coding with ICD-9-CM
- Procedures in ICD-10-CM
- HCPCS Level II
- HCPCS II Hierarchy
- HCPCS II Medication Flow Chart
- Current Procedural Terminology (CPT)
- AMA/CPT Code Book
- Symbols & Unlisted Codes
- CPT Surgical Guidelines
- Radiology and Pathology Guidelines
- Category II and III Codes
Advanced Medical Coding Module 3
Coding for Anesthesia, General Surgery and the Integumentary System
- AMA/CPT Evaluation and Management (E / M) Guidelines
- Criteria of Documentation
- E / M Selection
- Types of Anesthesia
- Anesthesia Coding
- General Surgery
- The Respiratory System
- The Cardiovascular System
- The Hemic and Lymphatic Systems
- The Digestive System
- The Urinary System
- The Nervous System
- The Ocular Adnexa and Auditory Systems
- E / M for Integumentary / Skin
- Surgical Guidelines for Integumentary
- Incision and Drainage
- Debridement
- Biopsy & Removal of Skin Tags
- Intralesional Injections and Tissue Expanders
- Graft Concepts and Tissue Transfer
- Repair and / or Reconstruction
Advanced Medical Coding Module 4
Coding for Orthopedics, Cardiology, and OB/GYN
- Fractures
- Dislocations
- Arthropathy
- Vertebral Disorders
- Sprains and Strains
- Cardiac and Vascular Anatomy & Physiology
- 90000 Series of CPT
- Intracardiac Electrophysiological Procedures
- Other Vascular Studies
- Noninvasive Vascular diagnostic Studies
- 30000 Series of CPT
- Radiology
- Using Modifiers Effectively
- Category II Codes
- Unique Aspects of Coding OB/GYN
- The Female Reproductive System
- Obstetrics and Gynecology (OB/GYN)
Advanced Medical Coding Module 5
Coding for Radiology, Pathology, Laboratory & General Medicine
- Radiology & CPT Coding
- Diagnostic Radiology & Ultrasound
- Radiation Oncology & Nuclear Medicine
- CPT – Pathology and Laboratory
- Evocative/Suppression Testing
- Hematology and Coagulation
- Transfusion Medicine
- Anatomic Pathology
- Surgical Pathology
- General Medicine Guidelines
- Immunization Administration
- Therapeutic Infusions & Injections
- Psychiatry & Psychiatric Therapeutic Care
- Dialysis
- Gastroenterology
- Ophthalmology
- Otorhinolaryngology Services
- Cardiology & Pulmonary
- Endocrinology
- Neurology and Neuromuscular Procedures
- Photodynamic Therapy & Dermatological Procedures
Advanced Medical Coding Module 6
Billing, Collections, Filing the Claim Form, Payment, & Inpatient Coding
- Patient Registration
- Ambulatory Patient Groups
- Payment and Billing Processes
- The Collections Process
- Professional Courtesy
- The Health Insurance Claim Form
- Medicaid & Medicare
- Submitting a Claim for a Deceased Patient
- Health Maintenance Organizations (HMOS)
- CHAMPUS / TRICARE / CHAMPVA
Workers' Compensation
- Encounter Forms, Superbills, Fee Slips, or Charge Tickets
- Step-By-Step Completion of a Paper CMS 1500 From
- Appealing the Claim
- Insurance Participation Agreements
- Denials, Rejections & Appeals
- Auditing & Fraud Risk Prevention
- Hospital Based ICD-9-CM Coding
- Unconfirmed Conditions
- Code Assignment
- Hospital Reimbursement Environment
Medical Coding Module 7
CCA Test Preparation – Part 1
- Examination Study Strategies and Resources
- Coding Review
- Health Data Content, Requirements, and Standards
- Medical Science
- Classification Systems and Secondary Data Sources
Medical Coding Module 8
CCA Test Preparation – Part 2
- ICD-9-CM Coding
- CPT Coding
- Medical Billing and Reimbursement Systems
- CCA Quiz
- CCA Mock Examination
Medical Billing
Course Overview:
Medical Billing is listed as one of the fastest growing professions in allied health. The medical industry is experiencing a tremendous demand for individuals with knowledge of medical office operations, which includes diagnostic and procedural insurance forms processing.
Our Medical Billing course will give you the skills you need to be competitive in the healthcare market place, as well as the credentials through certification to prove your qualifications. In this course, students will learn about managed health care, legal and regulatory issues, coding systems, reimbursement methods, coding for medical necessity, and common health insurance plans.
Upon successful completion of our Medical Billing course, students will be prepared for an entry-level position doing medical billing in a medical office setting and will be prepared to sit for the NHA national certification exam to become a Certified Billing and Coding Specialist (CBCS).
Course Outline:
Medical Billing Module 1
Medical Terminology
- Pronunciation
- Spelling
- Word Roots
- Combining Vowels/Form
- Prefixes
- Suffixes
- General Rules
- Word Building
- Abbreviations
- Procedural and Diagnostic Billing Codes
- Body Structure
- Organization of the Body
- Anatomical Position
- Body Planes
- Directional and Positional Terms
- Body Cavities
Medical Billing Module 2
Foundations of Health Insurance
- Health Insurance Specialist Career
- Job Responsibilities
- Professionalism
- Introduction to Health Insurance
- Medical Documentation
- Electronic Health Record (EHR)
- Managed Health Care
- Managed Care Organizations
- Effects of Managed Care
- Processing of an Insurance Claim
- Managing New Patients
- Insurance Claim Life Cycle
- Credit and Collections
- Legal and Regulatory Issues
- Health Insurance Portability and Accountability Act (HIPAA)
Medical Billing Module 3
Understanding Coding
- ICD-9-CM Coding
- Medical Necessity
- Outpatient Coding Guidelines
- Learning the ICD-9-CM Coding System
- CPT Coding
- CPT Sections, Subsections, Categories and Subcategories
- Coding Procedures and Services
- National Correct Coding Initiative
HCPCS Level II Coding
- HCPCS Level II National Codes
- Determining Payer Responsibility
Medical Billing Module 4
Reimbursement Methodologies
- CMS Reimbursement Methodologies
- CMS Payment System
- Ambulance Fee Schedule
- Ambulatory Surgical Center Rates
- Clinical Laboratory Fee Schedule
- Home Health Prospective Payment System
- Hospital Payment System
- Inpatient Psychiatric & Rehabilitation Payment System
- Skilled Nursing Facility Payment System
- Revenue Cycle Management
- Coding for Medical Necessity
- Applying Coding Guidelines
- Coding and Billing Considerations
- Coding from Case Scenarios
Medical Billing Module 5
Understanding Insurance
- Essential CMS-1500 Claim Instructions
- Insurance Billing Guidelines
- Optical Scanning Guidelines
- Entering Patient and Policyholder Names
- Recovery of Funds from Responsible Payers
- National Provider Identifier (NPI)
- Reporting Diagnoses: ICD-9-CM Codes
- Reporting Procedures and Services: HCPCS/CPT Codes
- Steps in Processing Claims
- Commercial Insurance
- Automobile, Disability and Liability Insurance
- Commercial Group Health Plan Coverage0
- Blue Cross Blue Shield (BCBS) Plans0
- Billing Notes & Claims Instructions
- BCBS Secondary Coverage
Medical Billing Module 6
Medicare & Medicaid
- Medicare Eligibility & Enrollment
- Medicare Parts A, B, C, & D
- Employer and Union Health Plans
- Medigap
- Mandatory Claims Submission
- Advance Beneficiary Notice
- Medicare Summary Notice
- Medicare-Medicaid (Medi-Medi) Crossover Claims
- Roster Billing for Mass Vaccination Programs
- Medicaid Eligibility
- Medicaid Covered Services
- Payment for Medicaid Services
- Mother/Baby Claims
- SCHIP Claims
Medical Billing Module 7
TRICARE & Workers' Compensation
- TRICARE Background & Administration
- CHAMPVA
- TRICARE Options
- TRICARE Programs
- TRICARE Supplemental Plans
- Billing Notes & Claims Instructions
- Federal Workers' Compensation Programs
- State Workers' Compensation Programs
- Eligibility for Workers' Compensation Coverage
Workers' Compensation and Managed Care
- First Report of Injury Form
- Progress Reports
- Appeals and Adjudication
- Fraud and Abuse
Medical Terminology
Course Overview:
Common medical terminology is a critical part of the language used by health care practitioners. It is essentially a vocabulary that requires a uniform pronunciation, definition, and spelling of terms used by professionals. Individuals with medical terminology training are capable of analyzing and interpreting medical reports related to specific body systems.
This program is appropriate for adults looking to learn new job skills, refresh or refine existing healthcare knowledge, or improve occupational performance by possessing a better understanding of medical terms.
This course discusses word construction and meanings that together characterize medical language. You must have access to the Internet to complete this program. At the end of this course, you'll be able to:
Identify medical terms and words by their component parts
Define the body structure and its systems, cavities, planes, and positions
Explain the importance of medical terminology in healthcare professions
Define and build the medical terms associated with the body systems
Course Outline:
Medical Terminology Module 1
Medical and Anatomical Terminology
- Word Root/Combining Forms
- Prefixes & Suffixes
- Word Examples Using Word Parts
- Information Frame
- Spell Check Tips
- Review Exercises
Medical Terminology Module 2
Blood Cells, Cardiovascular and Lymphatic Systems
- Word Root/Combining Forms
- Prefixes & Suffixes
- Word Examples Using Word Parts
- Information Frame
- Spell Check Tips
- Review Exercises
Medical Terminology Module 3
Nervous System and Tumors
- Word Root/Combining Forms
- Prefixes & Suffixes
- Word Examples Using Word Parts
- Information Frame
- Spell Check Tips
- Review Exercises
Medical Terminology Module 4
Digestive System
- Word Root/Combining Forms
- Prefixes & Suffixes
- Word Examples Using Word Parts
- Information Frame
- Spell Check Tips
- Review Exercises
Medical Terminology Module 5
Muscles, Bones and Joints
- Word Root/Combining Forms
- Prefixes & Suffixes
- Word Examples Using Word Parts
- Information Frame
- Spell Check Tips
- Review Exercises
Medical Terminology Module 6
Male Reproductive and Urinary Systems
- Word Root/Combining Forms
- Prefixes & Suffixes
- Word Examples Using Word Parts
- Information Frame
- Spell Check Tips
- Review Exercises
Medical Terminology Module 7
Female Reproductive System, Obstetrics and Neonatology
- Word Root/Combining Forms
- Prefixes & Suffixes
- Word Examples Using Word Parts
- Information Frame
- Spell Check Tips
- Review Exercises
Medical Terminology Module 8
Eye, Ear, Respiratory System and Special Senses
- Word Root/Combining Forms
- Prefixes & Suffixes
- Word Examples Using Word Parts
- Information Frame
- Spell Check Tips
- Review Exercises
Medical Terminology Module 9
Directions and Regions of the Body
- Word Root/Combining Forms
- Prefixes & Suffixes
- Word Examples Using Word Parts
- Information Frame
- Spell Check Tips
- Review Exercises
Medical Terminology Module 10
Pathogenic Organisms, Endocrine System and Medical Specialties
- Word Root/Combining Forms
- Prefixes & Suffixes
- Word Examples Using Word Parts
- Information Frame
- Spell Check Tips
- Review Exercises
Materials Included:
- Insurance Handbook for the Medical Office by Marilyn Fordney
- 2012 ICD-9-CM, Volumes 1, 2 & 3 Standard Edition by Carol J. Buck
- CPT 2012 Standard Edition by the American Medical Association
- Step-by-Step Medical Coding 2012 by Carol J. Buck
- Medical Terminology: A Short Course by Davi-Ellen Chabner
System Requirements:
Internet Access
- Broadband or high-speed internet access is required. Broadband includes DSL, cable, and wireless connections..
- Dial-Up internet connections will result in a diminished online experience. Moodle pages may load slowly and viewing large audio and video files may not be possible.
Hardware
- Windows hardware configurations and processors are acceptable.
- Mac computers MUST have Microsoft Window Operating Systems over Bootcamp (Bootcamp is a free download from Apple's website).
- 1 GB RAM recommended
- Software
- Operating Systems
- Windows XP or Vista and Mac OS X 10 and higher with Windows
- Web Browsers
- Google Chrome
- Internet Explorer 6, 7 and 8
- Safari, Internet Explorer & FireFox are not currently recommended as they cannot display certain Moodle editing menus for both students and instructors
Media Plug-ins (These may be required depending on your course media-click on the links below to download the latest versions)
- Adobe Flash Player
- Adobe Acrobat Reader
- Apple Quicktime
- Windows Media Player
- Real Player
- PowerPoint Viewer (use this if you don't have PowerPoint)
** Please be advised: October 2013 the ICD-9 will be replaced by the ICD-10-CM for the Physician's Office and ICD-10-PCS for Hospitals. All medical offices (medical billing, medical coding, and medical transcription) will still be using the ICD-9 until the end of 2013. The ICD-10 is VERY different than its predecessor the ICD-9. In order to be successful using the ICD-10 you will need to know Medical Terminology PLUS Anatomy & Physiology.
Each year our textbooks will be changing and updating to include more and more ICD-10 information. If you are taking any of our Allied Medical courses between now and 2013, you will need to take one or both of our ICD-10 courses in order to be able to professionally use the ICD-10 in 2013.