Medical Billing and Coding
The Medical Billing & Coding Profession
Medical billing and coding is one of the fastest-growing careers in the healthcare industry today! The need for professionals who understand how to code healthcare services and procedures for third-party insurance reimbursement is growing substantially. Physician practices, hospitals, pharmacies, long-term care facilities, chiropractic practices, physical therapy practices, and other healthcare providers all depend on medical billing and coding for insurance carrier reimbursement. The medical industry will have almost 50% more jobs available by 2018; therefore, a surplus of medical facilities will continue to hire candidates who specialize in medical billing and coding.
Effective October 1, 2015 the current standard for medical billing and coding will be updated from ICD-9 diagnosis codes to ICD-10-CM/PCS. While this process was originally delayed, the US Department of Health and Human Services (HHS) will now be requiring this update. That means all new medical coders will require training in ICD-10-CM/PCS codes and all existing coding professionals will need to make sure they're ready for the ICD-10-CM/PCS transition.
The Medical Billing & Coding Program
This billing and coding program delivers the skills students need to solve insurance billing and coding problems. It details proper assignment of codes and the process to file claims for reimbursement. This course covers the following key areas and topics
- An overview of healthcare and the insurance industry
- The organization and use of the ICD-10-CM/PCS, ICD-9, CPT, and HCPCS manuals to identify correct codes
- Detailed review and practice using the alphabetic index and tabular list of the ICD-10-CM/PCS and ICD-9
- Detailed review and practice coding examples from all sections within the CPT
- Basic claims processes for medical insurance and third-party reimbursements
- Completing common insurance forms, tracing delinquent claims, and appealing denied claims
Education and Certification
- Students should have or be pursuing a high school diploma or GED.
- Numerous national certification exams are available for students who complete this course including American Academy of Professional Coders (AAPC), American Health Information Association (AHIMA) and others.
- Certain national certification organizations suggest 6 months to 2 years of practical work experience prior to pursuing certain national certification exams.
Detailed Course Topics Covered
- Introduction to International Classification of Diseases, Clinical Modifications, Coding Guidelines
- Introduction to the organization and use of the ICD-10-CM/PCS, ICD-9 and CPT manuals
- Basics of diagnostic and procedural coding
- The Health Insurance Claim Form (CMS 1500)
- HIPAA and Electronic Data Interchange (EDI)
- Review and practice coding evaluation and Management (E&M) services
- Review and practice coding from anesthesia, surgery, radiology, medicine, and the pathology/laboratory sections of the CPT
- CPT Modifiers, E and V Codes, and Late Effects
- Coding surgical procedures of the integumentary system
- Coding surgical and medical procedures of the cardiovascular system
- Coding procedures related to the female genital system and maternity care and delivery
- Coding for general surgery, radiology, pathology and laboratory services
- Coding for diagnostic and therapeutic services and the Level II National Codes
- Tracing delinquent claims and insurance problem solving
- Third-party reimbursement issues