This course covers the skill set and knowledge required to fulfill a position as an Insurance Billing Specialist. This will include an introduction to diagnosis coding (ICD-9 and ICD-10), procedure coding (CPT and HCPCS), billing and reimbursement processes and understanding insurance companies; as well as Medical Insurance Billing as a Career, HIPPA & HITECH, Health Insurance basics, Medical Record Documentation, Electronic Data Exchange, Claim Reimbursement, Fees, BCBS, Managed Care, Private Insurance, Medicare, Medicaid, Tricare, CHAMPVA, Workers Compensation, and Disability Income Insurance.

Course Outline

Course Introduction

· Course Syllabus

· SMARTBOOK / EHRClinic Instructions

· EHRClinic Tutorial

· Course Introduction

Lesson 1 - The Insurance Specialist and Revenue Cycle

· Industry Insight: Question - Lesson 1

· Introduction and Objectives - Lesson 1

· Key Terms - Lesson 1

· McGraw - SMARTBOOK 1.1, 1.9. and 1.10 / Complete Questions

· The Medical Insurance Field

· McGraw - SMARTBOOK 1.2 / Complete Questions

· Medical Insurance Basics

· McGraw - SMARTBOOK 1.3, 1.4, 1.5, 1.6, and 1.7 / Complete Questions

· Types of Insurance

· McGraw - SMARTBOOK 1.8 / Complete Questions

· The Revenue Cycle and Insurance Math

· Review - Lesson 1

· Industry Insight: Follow-Up - Lesson 1

· Quiz - Lesson 1

Lesson 2 - Using and Protecting Health Information

· Industry Insight: Question - Lesson 2

· Introduction and Objectives - Lesson 2

· Key Terms - Lesson 2

· McGraw - SMARTBOOK 2.1 / Complete Questions

· The Medical Record and Documentation

· Consents

· McGraw - SMARTBOOK 2.2, 2.3, 2.4, 2.5, 2.6, and 2.7 / Complete Questions

· HIPAA, HITECH, and ACA

· Privacy and Security Rules

· McGraw - SMARTBOOK 2.8, 2.9, and 2.10 / Complete Questions

· Other Healthcare Laws and Regulations

· Confidentiality

· Review - Lesson 2

· Industry Insight: Follow-Up - Lesson 2

· Quiz - Lesson 2

Lesson 3 - The Patient Encounter

· Industry Insight: Question - Lesson 3

· Introduction and Objectives - Lesson 3

· Key Terms - Lesson 3

· McGraw - SMARTBOOK 3.1, 3.2, 3.3, and 3.4 / Complete Questions

· Patient Registration

· McGraw - SMARTBOOK 3.5, 3.6, 3.7, 3.8, and 3.9 / Complete Questions

· Establishing Financial Responsibility

· Time-of-Service Payments and Insurance Math

· Collecting Time-of-Service Payment

· Review - Lesson 3

· Industry Insight: Follow-Up - Lesson 3

· Quiz - Lesson 3

· Knowledge Assessment #1 - Insurance and Billing, and Coding Essentials

Lesson 4 - An Overview of the ICD-10-CM

· Industry Insight: Question - Lesson 4

· Introduction and Objectives - Lesson 4

· Key Terms - Lesson 4

· Development of the ICD-10-CM

· McGraw - SMARTBOOK 4.1, 4.2, and 4.3 / Complete Questions

· ICD-10-CM Alphabetic Index

· McGraw - SMARTBOOK 4.4 and 4.6 / Complete Questions

· Tabular List

· Review - Lesson 4

· Industry Insight: Follow-Up - Lesson 4

· Quiz - Lesson 4

Lesson 5 - Instructional Notations of the ICD-10-CM

· Industry Insight: Question - Lesson 5

· Introduction and Objectives - Lesson 5

· Key Terms - Lesson 5

· Conventions

· Official Instructional Notations

· McGraw - SMARTBOOK 4.5, 4.7, and 4.8 / Complete Questions

· ICD-10-CM Coding/Engagement Activity

· ICD-10-CM Coding/Practical Application

· Review - Lesson 5

· Industry Insight: Follow-Up - Lesson 5

· Quiz - Lesson 5

Lesson 6 - Introduction to CPT

· Industry Insight: Question - Lesson 6

· Introduction and Objectives - Lesson 6

· Key Terms - Lesson 6

· McGraw - SMARTBOOK 5.1, 5.2, and 5.3 / Complete Questions

· CPT Purpose and Sections

· McGraw - SMARTBOOK 5.4 / Complete Questions

· CPT Guidelines & Code Formats

· McGraw - SMARTBOOK 5.12 / Complete Questions

· Unlisted Procedures and Code Categories

· McGraw - SMARTBOOK 5.5 / Complete Questions

· CPT Index & General Coding Rules

· CPT Coding Scenarios

· Review - Lesson 6

· Industry Insight: Follow-Up - Lesson 6

· Quiz - Lesson 6

Lesson 7 - Introduction to HCPCS

· Industry Insight: Question - Lesson 7

· Introduction and Objectives - Lesson 7

· Key Terms - Lesson 7

· McGraw - SMARTBOOK 5.13 / Complete Questions

· HCPCS Levels and Groupings

· HCPCS Format & Tables

· Durable Medical Equipment and Physician Fee Schedule

· Review - Lesson 7

· Industry Insight: Follow-Up - Lesson 7

· Quiz - Lesson 7

· Knowledge Assessment #2 - Insurance and Billing, and Coding Essentials

Lesson 8 - Encounter Charges and Billing

· Industry Insight: Question - Lesson 8

· Introduction and Objectives - Lesson 8

· Key Terms - Lesson 8

· McGraw - SMARTBOOK 6.1, 6.2, and 6.3 / Complete Questions

· Billing Compliance

· McGraw - SMARTBOOK 6.4 / Complete Questions

· Compliance Strategies

· McGraw - SMARTBOOK 6.5 / Complete Questions

· Coding and Billing Cycle Audits

· McGraw - SMARTBOOK 6.6, 6.7, 6.8, 6.8, 6.9, 6.10, and 6.11 / Complete Questions

· Fees and Reimbursement

· Payment Methods and Insurance Math

· Review - Lesson 8

· Industry Insight: Follow-Up - Lesson 8

· Quiz - Lesson 8

Lesson 9 - The Healthcare Insurance Claim

· Industry Insight: Question - Lesson 9

· Introduction and Objectives - Lesson 9

· Key Terms - Lesson 9

· McGraw - SMARTBOOK 7.1, 7.2, and 7.3 / Complete Questions

· CMS-1500 Claim Completion

· McGraw - SMARTBOOK 7.4 / Complete Questions

· Complete a CMS-1500 Claim

· McGraw - SMARTBOOK 7.5 and 7.6 / Complete Questions

· HIPAA 837P Claim Submission

· McGraw - SMARTBOOK 7.7 and 7.8 / Complete Questions

· Claim Transmission

· McGraw - SMARTBOOK 17.3, 17.4, and 17.6 / Complete Questions

· Hospital Coding and Claims

· Capturing Insurance Information

· Review - Lesson 9

· Industry Insight: Follow-Up - Lesson 9

· Quiz - Lesson 9

Lesson 10 - Private and ACA Health Insurance

· Industry Insight: Question - Lesson 10

· Introduction and Objectives - Lesson 10

· Key Terms - Lesson 10

· McGraw - SMARTBOOK 8.1 / Complete Questions

· Group Health Insurance

· McGraw - SMARTBOOK 8.2 and 8.3 / Complete Questions

· Types of Private Health Insurance

· McGraw - SMARTBOOK 8.4 and 8.5 / Complete Questions

· Major Private Health Insurance Plans

· McGraw - SMARTBOOK 8.6, 8.7, 8.8, 8.9, and 8.10 / Complete Questions

· Provider Participation

· Preparing a Correct Claim

· McGraw - EHRClinic - Complete Exercises 8.4 A and 8.4B

· Review - Lesson 10

· Industry Insight: Follow-Up - Lesson 10

· Quiz - Lesson 10

Lesson 11 - Medicare

· Industry Insight: Question - Lesson 11

· Introduction and Objectives - Lesson 11

· Key Terms - Lesson 11

· McGraw - SMARTBOOK 9.1, 9.2, and 9.3 / Complete Questions

· The Medicare Program

· McGraw - SMARTBOOK 9.4 and 9.5 / Complete Questions

· Participating and Nonparticipating Providers

· McGraw - SMARTBOOK 9.6, 9.7, and 9.8 / Complete Questions

· Medicare Plans

· McGraw - SMARTBOOK 9.9 and 9.10 / Complete Questions

· Medicare Claims

· McGraw - EHRClinic - Complete Exercises 9.1, 9.2, and 9.3

· Review - Lesson 11

· Industry Insight: Follow-Up - Lesson 11

· Quiz - Lesson 11

· Knowledge Assessment #3 - Insurance and Billing, and Coding Essentials

Lesson 12 - Medicaid

· Industry Insight: Question - Lesson 12

· Introduction and Objectives - Lesson 12

· Key Terms - Lesson 12

· McGraw - SMARTBOOK 10.1 and 10.2 / Complete Questions

· The Medicaid Program

· McGraw - SMARTBOOK 10.3 / Complete Questions

· State Programs

· McGraw - SMARTBOOK 10.4, 10.5, 10.6, and 10.7 / Complete Questions

· Billing Procedures

· McGraw - SMARTBOOK 10.8 / Complete Questions

· Medicaid Claims

· McGraw - EHRClinic - Complete Exercises 10.1 and 10.2

· Review - Lesson 12

· Industry Insight: Follow-Up - Lesson 12

· Quiz - Lesson 12

Lesson 13 - TRICARE and CHAMPVA

· Industry Insight: Question - Lesson 13

· Introduction and Objectives - Lesson 13

· Key Terms - Lesson 13

· McGraw - SMARTBOOK 11.1, 11.2, 11.3, and 11.4 / Complete Questions

· The TRICARE Program

· McGraw - SMARTBOOK 11.5 / Complete Questions

· The CHAMPVA Program

· McGraw - SMARTBOOK 11.6 / Complete Questions

· Filing Claims

· McGraw - EHRClinic - Complete Exercises 11.1, 11.2, and 11.3

· Review - Lesson 13

· Industry Insight: Follow-Up - Lesson 13

· Quiz - Lesson 13

Lesson 14 - Other Compensation Plans

· Industry Insight: Question - Lesson 14

· Introduction and Objectives - Lesson 14

· Key Terms - Lesson 14

· McGraw - SMARTBOOK 12.1, 12.2, and 12.3 / Complete Questions

· Workers' Compensation Plans

· McGraw - SMARTBOOK 12.4 / Complete Questions

· Filing Workers' Compensation Plans

· McGraw - SMARTBOOK 12.5 / Complete Questions

· Disability and Automotive Compensation Plans

· McGraw - EHRClinic - Complete Exercises 12.1 and 12.2

· Review - Lesson 14

· Industry Insight: Follow-Up - Lesson 14

· Quiz - Lesson 14

Lesson 15 - Health Insurance Claim Follow-Up

· Industry Insight: Question - Lesson 15

· Introduction and Objectives - Lesson 15

· Key Terms - Lesson 15

· McGraw - SMARTBOOK 13.1 / Complete Questions

· Claim Adjudication

· McGraw - SMARTBOOK 13.2 / Complete Questions

· Claim Status

· McGraw - SMARTBOOK 13.3 and 13.4 / Complete Questions

· The Remittance Advice

· McGraw - SMARTBOOK 13.5, 13.6, and 13.7 / Complete Questions

· Posting and Applying Payments

· McGraw - SMARTBOOK 13.8 and 13.9 / Complete Questions

· Secondary Payers

· Claim Status

· Review - Lesson 15

· Industry Insight: Follow-Up - Lesson 15

· Quiz - Lesson 15

Lesson 16 - Billing and Collections

· Industry Insight: Question - Lesson 16

· Introduction and Objectives - Lesson 16

· Key Terms - Lesson 16

· McGraw - SMARTBOOK 14.1, 14.2, 14.3, and 14.9 / Complete Questions

· Patient Financial Responsibility

· McGraw - SMARTBOOK 14.4, 14.5, and 14.6 / Complete Questions

· Collections

· McGraw - SMARTBOOK 14.7 and 14.8 / Complete Questions

· Collections cont.

· Account Write-offs and Bad Debt Math

· Account Billing and Collection

· Review - Lesson 16

· Industry Insight: Follow-Up - Lesson 16

· McGraw - EHRClinic - Complete Optional Exercises 15.1-15.20

· Quiz - Lesson 16

· Knowledge Assessment #4 - Insurance and Billing, and Coding Essentials

Course Conclusion

· Course Conclusion