MB 211: Introduction to Health Insurance and Medical Billing
Focus on the basics of health insurance and the differences between the common types of insurance plans for medical and dental insurance. Private plans will be discussed as well as government plans, such as Medicare, Medicaid, TRICARE, workers’ compensation, and COBRA. The differences between managed care and commercial insurance will also be covered. Medical terminology relevant to the basics of health insurance/medical billing is introduced in this course.
MB 212: Coding Systems for the Medical Biller
This course covers the building blocks of the language of medical coding: diagnosis codes (ICD-9-CM: International Classification of Diseases), procedure codes (CPT: Current Procedural Terminology), and the national HCPCS (Healthcare Common Procedure Coding Systems). Focus on the proper use of medical codes on billing forms enables claims to get paid accurately and promptly. Learn to apply medical codes to specific claims using the standard CMS-1500 form. Medical decision making will be taught to convey the complexity of establishing a diagnosis and procedure(s) for a patient. Relevant medical terminology and modifiers, which are specific numbers that are appended to the procedure codes, are reviewed as well.
MB 213: Billing Medicare
Medicare sets the billing standards for all insurance companies. Learn how Medicare providers and suppliers are reimbursed for the items and services that they furnish, as well as how Medicare determines the services that they will deny. This course will focus on the different types of Medicare plans, Original Medicare (Part A and Part B), Medicare Advantage Plans (identified as Part C or MA), and Medicare Part D (PDP or Prescription Drug Plan). The differences between Medicare Part A (which includes hospitals, skilled nursing homes, hospice, and home health services) and Part B (provider billing, radiology and laboratory services, as well as speech, occupational, and physical therapy services, and DME [Durable Medical Equipment]) will be addressed. Allied health care providers, such as chiropractors, podiatrists, optometrists, and some mental health care professionals, also participate in the Medicare program; their services and how they are paid will also be discussed. In some cases, Medicare is not the primary insurance; Medicare Secondary Payer will also be thoroughly reviewed. Terms and expressions related to Medicare will be covered. Covered services such as surgery, laboratory, and physical and occupational therapy will be reviewed.
MB 214: Billing Managed Health Care and Commercial Insurance
This course focuses on the billing differences between managed care insurance, such as HMOs and PPOs, and commercial insurance, such as Blue Cross, Blue Shield, Aetna, etc. Medical billing issues related to billing managed care, including capitation, withholds, and physician incentives, will be explored. Procedures for billing secondary insurance, the “birthday rule,” and prior authorizations related to billing commercial insurance will be reviewed. Terminology that relates to managed health care and commercial health insurance will be covered.
MB 215: Billing Medicaid, Workers' Compensation, and TRICARE
Fundamentals of Medicaid, the federally and state-funded insurance plan, workers’ compensation (work-related injuries and illnesses), and TRICARE (active and retired military and their dependents) will be reviewed. This course focuses on the specific rules, procedures, and forms required for the proper submission of reimbursement claims under these types of insurance plans. Specific case scenarios will be utilized to enhance the student’s understanding of the reimbursement of claims under Medicaid, workers’ compensation, and TRICARE.
MB 216: The Life Cycle of an Insurance Claim and the EMR (Electronic Medical Record)
This course focuses on providing the student with an understanding of all fields on the CMS-1500 form, the standard claim form that most insurance companies require to process the payment of outpatient medical services. The course will discuss NPI (National Provider Identification), secondary insurance, and the modifier fields. This course also focuses on the understanding and the proper completion of the UB-04 (institutional claim form) used by ambulance companies, home health agencies, walk-in clinics, and other facilities. This course will also give the student hands-on experience using actual medical billing software commonly utilized in the medical billing community to help the student understand the concept of medical billing as it is applied in the medical provider’s office. The course will review Electronic Medical Records, which allows medical providers to keep patients’ medical information on the computer and eliminates the need for paper recordkeeping. The terms and words unique to this unit will be discussed.
MB 217: An Introduction to HIPAA (Health Insurance and Portability and Accountability Act of 1996) and Other Legal Issues
This course focuses on HIPAA standards designed to protect the security and confidentiality of electronic health information, including medical records and medical bills. Relevant HIPAA terminology will be presented as well as a review of the forms needed by a medical practice to be HIPAA compliant. HIPPA guidelines regarding the continuity and portability of health insurance will be addressed as well as the distinction between fraud and abuse. The overall impact of HIPPA on the medical billing industry will be studied.
MB 218: Medical Billing as a Business (Owning, Operating, and Marketing Your Own Medical Billing Business) and Career Opportunities for the Medical Biller
This course will focus on the fundamental and practical aspects of operating a medical billing business. Issues related to establishing a business practice will be addressed, including naming and setting up a business entity (solo owner, partnership, or corporation), tax responsibilities and liabilities, business insurance, equipment purchases, and grants and loan availability. Creating a business/marketing plan using software will be a focus in this unit.
Extensive marketing techniques directed toward the medical community are presented, including mailings, presentations, and phone solicitations. Students will be provided with the opportunity to role play their marketing presentation in preparation for their real-world business endeavors, as well as create brochures and marketing materials for their business. Students will gain experience using full practice management medical billing software and will have exercises that will simulate their own medical billing business.