Billing and Coding Professional Certification Prep Program

Billing & Coding

Accurate processing of health insurance claims has become more exacting and rigorous as health insurance plan options have rapidly expanded. These changes, combined with modifications in state and federal regulations affecting the health insurance industry, are a constant challenge to healthcare personnel. Those responsible for processing health insurance claims require thorough instruction in all aspects of medical insurance, including plan options, payer requirements, state and federal regulations, abstracting of source documents, accurate completion of claims, and coding of diagnoses and procedures/services. Understanding Health Insurance provides the required info clearly and comprehensively manner. The course was designed and revised to support core learning objectives with chapter objectives, content, and assessments aligned to ensure students learn and practice the concepts and skills they’ll need on the job. Student learning is supported through chapter outlines and measurable objectives identified at the beginning of each chapter, as well as chapter headings and assessments that map to those chapter outlines and objectives.

• Develop the ability to elaborate on the personal qualities and job responsibilities of a Billing and Coding employee.
• Assess the impact of OSHA and HIPAA in a medical office.
• Describe different types of Health Insurance.
• Obtain basic knowledge of Billing and Coding practices in the medical office.
• Gain knowledge of various written and verbal communications needed in a medical office and apply knowledge in processing and maintaining patient medical records that pertain to patient accounts.
• Demonstrate skills in filing insurance claims for the medical provider.
• Diagnostic Coding: Students will learn how to assign ICD codes to accurately represent a patient’s medical condition or diagnosis.
• Procedural Coding: CPT codes will be utilized to identify medical services and procedures performed by healthcare providers.
• Evaluation and Management (E/M) Coding: Students will understand the coding principles for documenting and billing for patient visits and consultations.
• Inpatient and Outpatient Coding: Different coding rules apply to inpatient and outpatient settings, and students will learn to differentiate between them.
• Medical Necessity: Understanding the concept of medical necessity and how it impacts coding and billing decisions.
• Modifiers: Students will learn how to use modifiers to provide additional information about procedures, services, or circumstances that may affect payment.
• Claim Submission and Reimbursement: The process of submitting claims to insurance companies and ensuring proper reimbursement will be covered in detail.
• Compliance and Auditing: Students will understand the importance of compliance with coding guidelines and learn how audits help ensure accuracy and compliance.

Upon completion of the Medical Billing and Coding Professional Program, graduates will be equipped to pursue career opportunities in hospitals, clinics, medical offices, insurance companies, and other healthcare facilities, playing a vital role in efficient medical billing and coding processes.