Medical Billing Career Prep Professional

MSM110 / Hours: 465 / Access Length: 12 Months / Delivery: Online, Self-Paced
Retail Price: $3,155.00 / Materials Included

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).

This course will provide you with key information about medical terminology systems. You will learn the key elements used to build medical terms. This will help you be able to decipher words on your own. You will also review body structure and the main systems of the human body. These include the integumentary, digestive, respiratory, and cardiovascular systems to name a select few. Through these learning experiences, you will learn how to recognize, pronounce. build and spell words related to the body structure. 

Participants will be asked to complete exercises at the end of each chapter as well as reference appendices in the back of the textbook to aid in the learning process. Furthermore, practice labs will be included in activities that will obtain credit for lessons with the course. 

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

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

The cost of the course INCLUDES the certification exam.

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 Terminology Career Prep Curriculum:

Lesson 1: Medical Terminology Basics

This lesson will help you be able to Identify the four-word elements used to build medical words. You will also learn how to divide medical words into their component parts and apply the basic rules to define and build medical words. You will learn how to interpret pronunciation marks so you can pronounce medical terms presented in this chapter.

Lesson 2: Body Structures

One of the most important parts of the course is understanding the organization of the body. While each person is unique in their own right, the way we are assembled as humans (in a general sense are nearly the same). For this lesson, upon understanding the different levels, planes, and regions of the body, participants will learn how to properly pronounce terms related to a body structure. Documenting health care activities will conclude this part of the course through the assigned activities provided.

Lesson 3: Integumentary, Digestive and Respiratory Systems

The third lesson of the course begins the comprehensive review of the major parts of the body. In this case, the first three (3) in focus are the integumentary, digestive, and respiratory systems. Better put, this lesson will provide comprehensive details and knowledge to understand medical terms specific to one's skin, digestive, and breathing systems. Anatomy and physiology reviews are included in the reading material so participants can not only comprehend terminology but also view where it is often located in these parts of the body. Additional supplemental materials located in the back of the text are available as additional study aids and reference for this and other core portions of the course.

Lesson 4: Cardiovascular, Blood, Lymphatic and Immune Systems

Continuing the discussion of core body systems, the fourth lesson reviews more specific systems which blood commonly flows through. This includes cardiovascular systems such as the heart, lymphatic systems, and more. Similar to other course lessons that focus on body systems, one will need to comprehend the aforementioned knowledge plus an understanding of various diseases or body issues that may result when malfunctions may occur. As mentioned in the previous lesson, additional supplemental materials located in the back of the text are available as additional study aids and reference for this and other core portions of the course.

Lesson 5: Musculoskeletal, Urinary, and Reproductive Systems

The fifth lesson of the course continues the focus of core body systems that medical professionals must understand in order to properly convey and use terms correctly. This lesson goes into great detail about musculoskeletal, urinary, and reproductive systems. These body systems are often dependent on others working properly and failure of those having issues or deficiencies will likely cause these to do the same or at worse fail. Participants should pay particular focus to the reproductive systems and their respective terms as they only apply to their gender and at times, it can be easy to confuse their respective terminologies. As part of a major reoccurring theme for the course, additional supplemental materials located in the back of the text are available as additional study aids and reference.

Lesson 6: Endocrine Systems

The second to last part of the course focuses on an ever-increasing medical base within the United States and the world - endocrinology. Endocrine systems provide the necessary functionality to help keep equilibrium within one's body and nutrients (e.g. glucose and insulin) to keep that balance in place. Hence, thyroid and diabetes care increasing in need, medical professionals must have a strong grasp of common terminology used in this space so that it can be communicated properly and effectively to patients and other medical personnel. To aid in the learning experiences in this important section of the course, additional supplemental materials located in the back of the text are recommended to be used in conjunction with required reading assignments.

Lesson 7: Nervous System and Special Senses

In the final lesson, participants will learn about one body system and special senses. You will be able to locate the major organs of each and describe their structure and function. You will also better understand how each relates to others in the body. You will also learn how to pronounce, spell, and build words related to all both. You will gain an understanding of diseases, conditions, and procedures related to each one as well. You will learn about pharmacology related to the treatment of disorders in each.  One is encouraged to apply cumulative learning experiences to the comprehension of terms learned here as well as additional resources that immediately follow this chapter in the text.

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).​

The cost of the course INCLUDES the certification exam.

System Requirements:

Internet Connectivity Requirements:

• Cable, Fiber, DSL, or LEO Satellite (i.e. Starlink) internet with speeds of at least 10mb/sec download and 5mb/sec upload are recommended for the best experience.

NOTE: While cellular hotspots may allow access to our courses, users may experience connectivity issues by trying to access our learning management system.  This is due to the potential high download and upload latency of cellular connections.   Therefore, it is not recommended that students use a cellular hotspot as their primary way of accessing their courses.

Hardware Requirements:

• CPU: 1 GHz or higher
• RAM: 4 GB or higher
• Resolution: 1280 x 720 or higher.  1920x1080 resolution is recommended for the best experience.
• Speakers / Headphones
• Microphone for Webinar or Live Online sessions.

Operating System Requirements:

• Windows 7 or higher.
• 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.

Web Browser Requirements:

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

Basic Software Requirements (These are recommendations of software to use):

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