This medical claims and billing training course highlights the key concepts and guidelines that underpin the billing process. This Course introduces you to the fundamentals of health insurance and reimbursement. You’ll learn principles of medical billing, as they relate to proper claim form preparation, submission and payment processing, and follow-up processes.
Health Insurance Models and Consumer Driven Health Plans
- Group vs individual health plans
- Health Maintenance Organizations (HMO)
- Managed Care Organizations (MCO)
- Accountable Care Organizations (ACO)
- Government payers
- Physician credentialing/NPI requirements
Patient Registration Process and Data Capture
- Overview of an office visit
- Patient types
- Demographic and insurance information
- Medical insurance coverage validation
- Authorization form
- Encounter form
- Discharge process/check-out
Current Procedural Terminology (CPT) Concepts
- Evaluation and management codes
- Anesthesia
- Surgery
- Radiology
- Laboratory
- Medicine
- Modifiers
HCPCS Level II Concepts
- HCPCS Level II codes
- HCPCS Level II modifiers
- Reporting for discarded drugs/medications
Billing
- Fee schedules
- Data entry
- Claim Forms
- Reduce payment delay
- Prior authorization
- Claim scrubbers
- A/R deposit balancing
- Technology and insurance claims submission
- Audits
- Hospital facility billing
- Primary vs secondary insurance
Accounts receivable (A/R) and Collection Concepts
- Explanation of Benefits (EOB) and Remittance Advice (RA)
- A/R management
- Denials and appeals
- Patient statements
- Refunds
- Professional courtesy, discounts, and financial hardship
- Patient collection practices
- Bankruptcy concepts
