Course Content

Introduction to Health Insurance provides an overview of the insurance industry and defines the scope of Health Insurance; Disability and Liability Insurance; Major Developments in Health Insurance; Health Insurance Coverage Statistics; Third Party Reimbursement Methods, etc.

Anatomy, Physiology and Terminology (Admin. & CBCS, not for clinical rotations) introduces students to medical terminology and includes the basics of anatomy and physiology, medical history, examination procedures, and medical reports.

Medical Laws and Ethics examine the role of the Billing & Coding Specialist and the laws that relate to this role. Special emphasis on OSHA regulations; Employer and Employee Liability; Patients’ Bill of Rights; Americans with Disabilities Act; False Claims Act; and Fraud.

Medical Office Skills is designed to familiarize students with basic office protocols for the medical environment. Students will learn the general principles to communicate effectively in a medical environment by composing business letters, memos and reports. Students will develop proof reading skills; review grammar, spelling and vocabulary.

The Insurance Claims Process is designed to teach students about the medical insurance claims process. Students will learn: Developments of the Claim; New Patient Interview and Check-in Procedure; Established Patient Return Visit; Post Clinical Check-out Procedure; Insurance Company Processing of a Claim and Maintaining Insurance Claim Files.

ICD-9/10-CM Coding is intended to familiarize students with the Diagnostic Coding System (ICD-9/10-CM); HCFA ICD-9/10-CM Coding Guidelines; Primary and Principal Diagnosis Coding; Principal versus Secondary Procedures; Coding Qualifying Diagnosis; ICD-9/10-CM Coding System; Disease Index Organization; Basic Steps for Using the Index; Organization of the Tabular List; Basic Steps for Using the Tabular List; Working with Index to Disease Tables; Coding Special Disorders; and Considerations to Ensure Accurate ICD-9/10-CM Coding.

CPT Coding is intended to familiarize students with the importance of Procedural Coding Skills (CPT Coding System); PT Format; CPT Symbols and Conventions; Tabular Conventions; Index Conventions; CPT Index; Basic Steps for Coding Procedures and Services; Surgery Overview; Coding Special Surgery Cases; Medicine Section Overview; Radiology Section Overview; Pathology/Laboratory Section Overview; Assigning Evaluation and Management Codes; and CPT Modifiers.

Medical Documentation provides an understanding of the medical documentation process.  Students will learn the guidelines for documentation; medical records; and laws governing privacy of medical documents.  Students will be able to apply ICD-9/10-CM Coding Guidelines; CPT/HCPCS Billing Considerations; Code Clinical Scenarios; Code Medical Reports; and Code Operative Reports.

Filing Commercial Claims provides students with an entry-level knowledge of the commercial insurance claim; Insurance Program Comparison Chart; Step-by-Step Insurance for Primary Commercial Claims; Patient and Policy Identification; Diagnostic and Treatment Data; Instructions for Block 24; Provider/Billing Entity Identification; and Commercial Secondary Coverage.

Blue Cross and Blue Shield provides students with an entry level knowledge of the national Blue Cross Blue Shield program; Participating Providers; Nonparticipating Providers; Traditional Fee-for-Service Coverage; National Accounts; Blue Card Program; BCBS & Managed Care; Medicare Supplemental Plans; Billing Information Summary; Step-by-Step Instructions – Primary BCBS Claims; Two BCBS Full Benefit Policies; BSBC Secondary Claims.

Medicare provides students with an entry level knowledge of Medicare. Concepts covered include: Eligibility; Medicare Enrollment; Part A/Part B Coverage; Participating Providers; Nonparticipating Provider Restrictions; Private Contracting; Advance Beneficiary Notices; Medicare Fee Schedule; Medicare as a Secondary Payer; Billing Notes; Step-by-Step Claim Form Instructions; Primary Medicare with a Medigap Policy; Medicare-Medical Crossover Claims; When Medicare is the Secondary Payer.

Medicaid provides students with an entry level knowledge of Medicaid. Concepts covered include: Federal Eligibility Requirements; Medicaid Services; Relationship between Medicaid and Medicare; Medicaid’s Future; Medicaid as a Secondary Payer; Participating Providers; Medicaid and Managed Care; Billing Information Notes; Claim Form Instructions; Secondary Medicaid Claims; Mother/Baby Claims.

TRICARE familiarizes students with the TRICARE Option; TRICARE Programs; Covered Services –TRICARE Standard; Program for Persons with Disabilities.

Workers Compensation provides students with an entry level knowledge of Workers Compensation and other Federal Compensation Programs; State-Sponsored Coverage; Eligibility Classification of On-the-Job Injuries; Special Handling of Workers Compensation and Managed Care; First Report of Injury; Progress Reports; Billing Information Notes; Workers Compensation Claim Instructions; – Patient and Policy Identification; Diagnostic and Treatment Data; Provider/Billing Entity.

Delinquent Claims & Insurance Problem Solving familiarizes students with Claim Management Techniques; Review and Appeal Process; Problem Claims; Rebilling.

Computerized Billing is intended to familiarize students with the concepts of computerized billing by introducing them with the functions and types of software used in the field.

Career Development provides a brief overview on resume development, soft skills, interviewing strategies, and decision-making skills relative to assist the student in obtaining employment in the field.

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