Course Content

Introduction to Health Insurance

Introductory session that gives an overview of the insurance industry; what is Health Insurance? Disability and Liability Insurance; Major Developments in Health Insurance; Health Insurance Coverage Statistics; Third Party Reimbursement Methods.

Anatomy, Physiology and Terminology (Admin. & CBCS, not for clinical rotations)

This session introduces students to medical terminology and includes the basics of anatomy and physiology, medical history, examination procedures, and medical reports. Students will begin developing a medical vocabulary through a study of roots, prefixes, and suffixes, and practices of correct pronunciation and usage of terms related to the body systems.

Medical Laws and Ethics

This session examines 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

This session is designed to introduce the student to 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. Students will demonstrate professionalism when speaking to patients.

The Insurance Claims Process

This is a course designed to teach the 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-CM Coding

This course is designed to teach students about the Diagnostic Coding System, (ICD-9-CM); HCFA ICD-9-CM Coding Guidelines; Primary and Principal Diagnosis Coding; Principal versus Secondary Procedures; Coding Qualifying Diagnosis; ICD-9-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-CM Coding.

CPT Coding

This session is designed to teach students about 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

Students will gain a thorough 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-CM Coding Guidelines; CPT/HCPCS Billing Considerations; Code Clinical Scenarios; Code Medical Reports; Code Operative Reports.

Filing Commercial Claims

This is a session designed to teach the students about 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; Commercial Secondary Coverage.

Blue Cross and Blue Shield Plans

This is a session designed to teach the students about 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

This is a session designed to teach the students about Medicare. Concepts covered to included: 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

This is a session designed to teach the students about 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; Step-by-Step Claim Form Instructions; Secondary Medicaid Claims; Mother/Baby Claims.

TRICARE

This is a session designed to teach the students about the TRICARE Option; TRICARE Programs and Demonstration Projects; TRICARE Service Centers; Beneficiary Counseling and Assistance Coordinator; TRICARE Preauthorization; Covered Services – TRICARE Standard; Program for Persons with Disabilities; Non-Covered Services – TRICARE; Medical Review; CHAMPVA; TRICARE as a Secondary Payer; TRICARE Billing Information; TRICARE Primary Claim Instructions; Primary TRICARE with a Supplemental Policy; TRICARE as Secondary Payer Claim Instructions.

Workers Compensation

This is a session designed to teach the students about the 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.

Tracing Delinquent Claims & Insurance Problem Solving

Claim Management Techniques; Review and Appeal Process; Problem Claims; Rebilling.

Computerized Billing

This c session is designed to teach the students the concepts of computerized billing utilizing the Medisoft software. Students will have a basic understanding of the software program.

Career Development

This session is designed to assist the student in resume development, soft skills, interviewing strategies and decision-making skills relative to this field to assist the student in obtaining employment.