MEDICAL CLAIMS & BILLING COURSE OUTLINE
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You get everything you need to know in easy-to-understand lessons that take you step-by-step from the basics of medical terminology, anatomy, and diagnosis and treatment of disease, through coding procedures and processing medical claims. This gives you a preview of what you will learn.
Click on the instruction links below for complete course content.
Instruction Pack 1
Instruction Pack 2
Instruction Pack 3
Instruction Pack 4
Instruction Pack 5
Medical Claims & Billing Instruction Pack I Back to Top
The Exciting World of Medicine and Medical Claims
Your first lesson is your introduction to the medical billing
process as a whole, from checking in patients to depositing
payments from insurance providers.
How Insurance Works
You will learn the language of health insurance and become
familiar with the types of insurance programs in use today.
Handling Claims
This lesson covers important insurance concepts,
preauthorization, diagnostic and procedure coding, as well
as proper procedures for follow-up.
Career Opportunities as a Medical Billing Specialist
Explore the many options open to claims and billing
specialists. Begin to assess which career is the best fit for you.
Medical Terminology - Word Parts
Medicine has its own language. Discover the basic building
blocks of all medical terms: root words, prefixes and suffixes.
Medical Terminology-Dividing and Combining Medical Terms
Continue your study of the language of medicine. You will
learn the specific rules of dividing a medical term into its
word parts.
Also included in Pack I:
• Course Introduction
• School Catalog
• Medical Claims Glossary
• Quick-Learn Kit, including CD and Flashcards
• Quiz Answer Sheets and Envelopes
Medical Claims & Billing Instruction Pack II Back to Top
Abbreviations, Symbols and Special Terms
Learn the abbreviations and symbols commonly used in
medicine, as well as eponyms, sound-alikes, opposites and
rules for medical plurals.
Introduction to Anatomy
It is important for everyone working in the field of medicine
to understand the relationships between anatomy, physiology
and pathology.
The Anatomy of the Human Body
This lesson gives detailed instruction on the anatomy of the
human body from cells to tissues to organs to organ systems.
Organ Systems I
Five organ systems are covered in this lesson:
musculoskeletal, neurological, cardiovascular, immune and
integumentary (skin).
Organ Systems II
The five remaining organ systems—respiratory,
gastrointestinal, genitourinary (male), reproductive (female),
and endocrine (glands)—are discussed.
Medicaid and Medicare
Find out about the government programs of Medicaid,
Medicare, Medigap and Medi-Medi plus the HCPCS system.
Also included in Pack II:
• Human Anatomy Flashcards
• Quiz Answer Sheets and Envelopes
Medical Claims & Billing Instruction Pack III Back to Top
Private Insurance and Managed Care Programs
Learn the characteristics of private and group health care
insurance, including HMOs, PPOs, POS plans and PPGs.
Military Insurance, Workers’ Comp
and COBRA
Medical coverage offered through TRICARE and CHAMPVA
are presented in this lesson, as well as workers’ compensation
and disability insurance.
Diagnostic (ICD-9-CM) Coding
Go step by step through the International Classification
of Diseases (ICD) and learn how to use the ICD-9-CM to
correctly code a physician’s diagnosis. Discover how to
handle coding in important situations, such as unconfirmed
diagnoses, multiple diagnoses and late effects coding.
Procedure Coding
Learn about procedure coding, including how to use Current
Procedural Terminology (CPT) book format. Also learn about
modifiers, methods of payment and the Health Care Financing
Administrative Common Procedure Coding System (HCPCS).
Integrating ICD-9-CM and CPT Codes
Find out how to integrate ICD-9-CM and CPT codes, and
practice assigning them to patient scenarios.
Determining Payment
Discover the many methods used to determine the amount
reimbursed to providers. You will learn about the usual,
customary and reasonable standard, fee schedules and relative
value studies.
Also included in Pack III:
• Human Anatomy Flashcards
• Quiz Answer Sheets and Return Envelopes
Medical Claims & Billing Instruction Pack IV Back to Top
Completing the CMS-1500 Claim Forms
This lesson gives detailed instructions for completing the
CMS-1500 insurance claim form, with special considerations
necessary for Medicare and Medicaid.
Completing the CMS-1500 Claim Form for
Various Carriers
Here you will review processing the CMS-1500 forms,
confidential physician files and patient forms. You will use
your new knowledge as you complete the claim form for
various carriers in extensive, hands-on practice.
Preparing UB-04 (CMS-1450) Form
Learn step by step how to complete the UB-04 insurance form
primarily used in hospitals.
Medical Billing Technology
You’ll receive in-depth, easy-to-understand instruction on the
evolving technology of the claims field.
Also included in Pack IV:
• Computers - A Buyer's and User's Guide
• Claims Resource Supplement
• Quiz Answer Sheets and Envelopes
• Electronic Claims Software –– Educational Version
Medical Claims & Billing Instruction Pack V Back to Top
Interpreting EOB Statements
This lesson will enable you to read and understand the
explanation of benefits received from various insurance carriers.
Secondary Claims and Managing Accounts
Learn about preparing secondary claims and how to manage
accounts receivable and insurance logs.
Solving Problems with Insurance Carriers,
Physicians and Patients
Learn how to deal with insurance companies and patients when
there is a problem with a claim or bill. You will get step-bystep
instruction on following through on insurance, patient and
physician problems.
Legal Issues Affecting Medical Claims
and Records
Learn about liability insurance, insurance audits,
malpractice claims and the requirements of the
new HIPAA guidelines.
Also included in Pack V:
• Medical Claims and Billing Jobs Finder
• Quiz Answer Sheets and Return Envelopes
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