Medical billing and coding professionals keep records, calculate patient charges and review files. Duties include: reviewing records; calculating charges for a patient’s procedure and service and preparing itemized statements and submitting claims to third party payers. Medical Coders are responsible for the collection of physician charges and patient data to ensure that claims are submitted to insurance carriers accurately and in the most efficient and expeditious manner. Additionally, Medical Coders determine codes for physician procedures and diagnosis - using ICD-9 and CPT-4 coding protocols - for third party billing purposes.
Medical Billing & Coding Professional – Employment & Education
Medical Billing and Coding is one of the fastest growing careers in the health care industry today!
The need for professionals that understand how to code health care services and procedures for third party insurance reimbursement is growing substantially. Physician practices, hospitals, pharmacies, long-term care facilities, chiropractic practices, physical therapy practices and other health care providers all depend on medical billing and coding for insurance carrier reimbursement.
50-hour course. Instructors: Karen Reger & Toni Potts
| Course Objectives
The course covers the following areas: CPT (introduction, guidelines, evaluation and management, and specialty fields such as surgery, radiology and laboratory), ICD-9 (introduction and guidelines), basic terminology, basic claims process for medical insurance and third-party reimbursements. Students will learn how to find the service and codes using the manuals (CPT, ICD-9 and HCPCS).
Also, technicians will be needed to enter patient information into computer databases to comply with Federal legislation mandating the use of electronic patient records.
Medical Coding Section Outline
The 30-hour medical coding training courses teach the fundamentals of medical coding and prepare the student for certification and helps them establish a career in the medical coding industry. Learn the fundamentals of medical coding and dissect real-world medical cases and charts to extract the most relevant information. The healthcare industry, complex and rigorous even for the most knowledgeable and thorough of professionals, requires that paperwork be submitted both in a highly accurate and very timely manner.
The area of healthcare involving the completion of paperwork outlining patients' billing histories and submission of them to the individual's insurance company for reimbursement is known as 'medical billing'. Within medical billing there exists the practice of 'medical coding' whereby codes are assigned to medical procedures and diagnoses in order to relay--in a universally accepted medical language--information to the insurance company or in some cases, governmental agencies and/or consulting firms.
Also known as 'insurance coding', medical billing/coding is viewed to be essential to the healthcare industry for it creates and maintains a single, unified language by which all (physicians, medical administrators, insurance companies, government healthcare officials) integrated parties are able to effectively communicate.
In this section of the program the topics covered include the following:
- Introduction to International Classification of Diseases, Clinical Modifications, Coding Guidelines
- Diagnosis Coding, , E and V Codes and Late effects
- Documentation guidelines and legal issues affecting insurance claims and medical records
- Introduction to CPT Manual
- Evaluation and Management services and CPT modifiers
- Anesthesia/Surgery, Radiology and Pathology/Laboratory Medicine
- Basics of health insurance and procedural coding (introduced during Coding and further explained during Billing)
Medical Billing Section Outline
The 20-hour billing section will include the following. Students will be introduced to a practical approach to basic comprehension of medical insurance programs and be introduced to the legal and regulatory issues. The student will also be introduced to medical office simulation software (MOSS) which helps prepare to work with any commercial software that is used in medical offices. This software includes building and editing patient records, scheduling appointments, billing patients and insurance companies and generating reports.
- Define health insurance
- Define terminology associated with medical insurance
- Explain the different Insurance such as BCBS Traditional, FEP, Managed Care, Military Insurance and Medicaid
- Distinguish between Medicare Part A, Medicare Part B, Part C and D.
- Explain the purpose of reporting diagnosis codes on insurance
- Accurately assign CPT codes to procedures and services.
- Understand and complete medical code entry
- Create electronic patient files
- Post patient charges and payments
- Electronically schedule patient appointments
- Edit and manage electronic patient files
- Understand and process electronic insurance company billing
- Electronically post insurance company payments
- Create and print necessary documents and reports
Method of Instruction
Medical Billing Textbooks:
Understanding Health Insurance A Guide to Billing and Reimbursement, 10th Edition Green, Rowell; and Workbook to Accompany Understanding Health Insurance A Guide to Billing and Reimbursement, 10th Edition; Green, Hernandez, Delmar Cengage Learning; 2010.
2012 ICD-9-CM; 2013 HCPCS Level II Volumes 1, 2 & 3; CPT 2013– Current Procedural Terminology Standard Edition
For those looking to pursue a National Certification Exam:
- Students should have or be pursuing a high school diploma or GED.
- Numerous national certification exams are available for students who complete this course including the American Academy of Professional Coders (AAPC) - Certified Professional Coder Exam (CPC or CPC-H - Apprentice); the American Health Information Management Association (AHIMA) Certified Coding Associate (CCA) exam; and/or other National Certification Exams.
- Certain national certification organizations suggest 6 months to 2 years of practical work experience prior to pursuing certain national certification exams.
Please note: national certification exams are not administered by SVSU. Our program is a preparatory course. If you would like more information regarding national certifications, please contact that organization directly.
CANCELLATION POLICY: A full refund will be given to those who cancel 3 weeks prior to the start of a class. Cancellations made 2 weeks prior to the start of class will receive refund, less 25% cancellation fee. Cancellations made less than 1 week prior to the start of the class will be eligible for 50% refund. No refunds will be honored after the first day of class. Should the books be returned in like-new condition and with no markings prior to the start of the second class, only the applicable cancellation fee will be assessed.
CLASS MINIMUM/MAXIMUM POLICY: This class must have a minimum of 8 students and a maximum of 24. If the class does not meet the minimum requirement it may be rescheduled.