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.