Medical Billing and Coding

(MED-BILL.AE1)/ISBN:978-1-64459-474-2

This course includes
Lessons
Lab
Medical Billing and Coding

Lessons

22+ Lessons | 102+ Flashcards | 102+ Glossary of terms

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Lessons 1: Introduction

  • About This Course
  • Icons Used in This Course
  • Where to Go from Here

Lessons 2: Dipping Your Toes into Medical Billing and Coding

  • Coding versus Billing: They Really Are Two Jobs
  • Following a Day in the Life of a Claim
  • Keeping Abreast of What Every Biller/Coder Needs to Know
  • Deciding Which Job Is Right for You
  • Prepping for Your Career: Training Programs and Certifications
  • Planning for the Future

Lessons 3: Exploring the Billing and Coding Professions

  • Looking at the Medical Coding Job
  • Breaking Down the Medical Biller’s Job
  • In Tandem: Working Together or Doing Both Jobs Yourself?

Lessons 4: Weighing Your Employment Options

  • Choosing Your Environment: Doctor’s Office, Hospital, and Others
  • Remote Access: Setting up Off-Site
  • Reviewing Other Work Options: Freelancing, Temping, and More
  • Heeding a Word of Advice for New Coders

Lessons 5: Compliance: Understanding the Rules

  • You Rule! Meeting the Rule Makers
  • Complying with HIPAA
  • Unbundling the Compliance Bundle
  • Getting the Most out of the Dreaded Audit

Lessons 6: Not-So-Strange Bedfellows: Medical Terminology and Medical Necessity

  • Brushing Up on Basic Anatomy
  • Say What? Deciphering Medical Terminology
  • Understanding Medical Necessity
  • Scrubbing In: Proving Medical Necessity for Surgical Procedures
  • Connecting with the World of Evaluation and Management Codes

Lessons 7: Getting to Know the Payers

  • Wading through Commercial Insurance Payers
  • Medicare: Meeting the Chief Government Payer
  • Working with Other Government Payers

Lessons 8: Your Basic Certification Options, Courtesy of the AAPC and AHIMA

  • Introducing the Two Main Credentialing Organizations: AAPC and AHIMA
  • Looking at the Basic Certifications
  • Choosing the Certification That’s Right for You
  • Examining the Exams: A Quick Review of the Main Tests

Lessons 9: The Path to Certification: Finding a Study Program

  • The Big Picture: Thinking about Your Degree and Career Objectives
  • Considering the Time Commitment
  • First Things First: Squaring Away Your Prerequisites
  • Picking a Program of Study
  • Caveat Emptor: Watching Out for Diploma Mills

Lessons 10: Signing Up and Preparing for the Certification Exam

  • Establishing a Study Routine and Strategy
  • Focusing on the Right Topics
  • Preparing Yourself for Test Day
  • Signing Up for and Taking the Big Test

Lessons 11: Adding Street Cred: Specialty Certifications and Continuing Ed

  • Introducing Specialty Certification Options
  • Building on Your Cred with Continuing Education

Lessons 12: Processing a Run-of-the-Mill Claim: An Overview

  • Dreaming of the Perfect Billing Scenario
  • Delving into the Details: Contract Specifics
  • Covering Your Bases: Referrals and Preauthorization
  • Tracking Your Claim from Submission to Payment
  • Fighting for Proper Payment: Filing an Appeal with the Payer

Lessons 13: Homing In on How to Prepare an Error-Free Claim

  • Assigning CPT Codes
  • Applying Modifiers Correctly
  • Looking for Money Left on the Table
  • Checking and Double-Checking Your Documentation

Lessons 14: From Clearinghouse to Accounts Receivable to Money in the Pocket

  • Spending Time in the Clearinghouse
  • Facing Factors Affecting Reimbursement Amounts
  • Payment or Denial: Being in the Hands of the Payer
  • Breaking Down the Remittance Advice

Lessons 15: Handling Disputes and Appeals

  • Dealing with Disputes Involving Contract and Non-Contracted Payers
  • Knowing When to File an Appeal: General Guidelines
  • The Art of the Appeal: Understanding the Basics before You Begin
  • Going through an Appeal, Step by Step
  • Appealing Medicare Processing
  • Appealing a Workers’ Comp Claim

Lessons 16: Keeping Up with the Rest of the World

  • WHO’s on First: Providing Data to the World Health Organization
  • Charting Your Course with ICD
  • Moving beyond ICD-10

Lessons 17: Dealing with Commercial Insurance Claims

  • Meeting Commercial Insurance
  • Cashing In with Commercial Payers
  • Knowing What’s What: Verifying the Patient’s Plan and Coverage

Lessons 18: Caring about Medicare and Medicaid

  • Brushing Up on Medicare Basics
  • Working with Medicare Claims
  • Deciding What Gets Paid
  • Working with Medicare Contractors
  • Doing Business with Medicare Part C Plans
  • Verifying Coverage and Plan Requirements

Lessons 19: Coding Ethics: Being an Advocate for Your Employer

  • Playing the Part of the Professional Medical Biller/Coder
  • Protecting Yourself and Your Integrity
  • Getting the Most Bang for Your Client’s Buck — Honestly

Lessons 20: Ten Common Billing and Coding Mistakes and How to Avoid Them

  • Being Dishonest
  • Shifting the Blame
  • Billing More than Is Documented
  • Unbundling Incorrectly
  • Ignoring an Error
  • Mishandling an Overpayment
  • Failing to Protect Patients from Out-of-Network Penalties
  • Failing to Verify Prior Authorization
  • Breaking Patient Confidentiality
  • Following the Lead of an Unscrupulous Manager

Lessons 21: Ten Acronyms to Burn into Your Brain

  • ACA: Patient Protection and Affordable Care Act
  • ACO: Accountable Care Organization
  • CDI: Clinical Documentation Improvement
  • CMS: Centers for Medicare & Medicaid Services
  • EHR: Electronic Health Record
  • EOB: Explanation of Benefits
  • HIPAA: Health Insurance Portability and Accountability Act
  • INN: In-Network
  • NCCI: National Correct Coding Initiative
  • OON: Out-of-Network

Lessons 22: Ten (Plus One) Tips from Billing and Coding Pros

  • Insist on Proper Documentation
  • Verify Patient Benefits
  • Get Vital Patient Info at Check-In
  • Review the Documentation ASAP
  • Set Up a System to Ensure Accuracy
  • Play Nice with Others
  • Follow Up on Accounts Receivable Daily
  • Be a Bulldog on the Phone
  • Know Your Payer Contracts by Heart
  • Create a File System That Lets You Find What You Need
  • Make Payers Show You the Money!

Hands-on LAB Activities (Performance Labs)

Dipping Your Toes into Medical Billing and Coding

  • Gaining Knowledge about Federal and State Regulations
  • Knowing about Billing and Coding Job

Exploring the Billing and Coding Professions

  • Learning about Super-Bill
  • Looking at the Medical Coding Job
  • Verifying Documetation
  • Choosing Medical Coding as a Profession
  • Understanding the CMS-1500 Form
  • Understanding Payers and Organizations
  • Knowing about the HCFA/CMS-1500 Form

Compliance: Understanding the Rules

  • Understanding HHS agency
  • Working with OIG
  • Understanding HIPAA Titles
  • Working with Key Provisions of HIPAA
  • Understanding Compliance Bundle
  • Learning about Laparoscopic Procedure

Not-So-Strange Bedfellows: Medical Terminology and Medical Necessity

  • Knowing about Medical Terminologies
  • Learning about Arthroscopic Surgery
  • Learning about Hospital Visit Code
  • Examining Patient Status

Getting to Know the Payers

  • Understanding Commercial Plans
  • Learning about TPAs
  • Identifying the Carriers
  • Working with Medicare Type
  • Understanding Payouts
  • Knowing about Tricare Program

Your Basic Certification Options, Courtesy of the AAPC and AHIMA

  • Getting to Know about the AAPC Certifications
  • Understanding AHIMA Certifications

The Path to Certification: Finding a Study Program

  • Learning about Online Programs
  • Learning about Community College

Signing Up and Preparing for the Certification Exam

  • Learning about Respiratory System
  • Learning about Endocrine System
  • Learning about Muscular System
  • Understanding Digestive System

Adding Street Cred: Specialty Certifications and Continuing Ed

  • Understanding AAPC Certifications

Processing a Run-of-the-Mill Claim: An Overview

  • Learning about Contracts
  • Knowing about Carve-Outs
  • Knowing about Prior Authorization

Homing In on How to Prepare an Error-Free Claim

  • Assigning CPT Codes
  • Applying Modifiers Correctly
  • Understanding Tricare

From Clearinghouse to Accounts Receivable to Money in the Pocket

  • Understanding Insurance Claim

Handling Disputes and Appeals

  • Appealing Medicare Processing

Keeping Up with the Rest of the World

  • Working with the 5010 Platform

Dealing with Commercial Insurance Claims

  • Cashing In with Commercial Payers

Caring about Medicare and Medicaid

  • Knowing about Advance Beneficiary Notice

Coding Ethics: Being an Advocate for Your Employer

  • Avoiding Accusations of Fraudulent Billing

Ten Acronyms to Burn into Your Brain

  • Learning about Medical Offices
  • Understanding HIPPA
  • Understanding NCCI