This course is designed to introduce the beginning student to the basic principles of insurance terminology, health insurance and medical billing. In addition, the student will contemplate the impact of health insurance on today’s economy. We will also cover the different departments within an insurance company and operations. This phase will also give the student the opportunity to understand the importance of legal issues that affect the medical biller and health claims examiner. Students will be taught fundamentals of health information technology to provide them with the importance of written communication skills, accounts receivable management, supportive documentation, and customer service. 

This course is designed to provide the student with the understanding and practical skills necessary to abstract relevant information from the medical records for completing the CMS-1500 claim form, as well as completely expediting the logins and processing of different types of medical forms. Students will study general guidelines for completing forms for different carriers to include: Medicare, Medicaid, and Workers’ Comp. This course will teach the student the knowledge necessary to optimize payment in a timely and cost efficient manner. The students will study the difference between clean, pending, rejected, incomplete and invalid claims and describe the reasons why claims were rejected. This course will also provide the student with the necessary skills to understand and complete the UB-92 claim form and to know when it may or may not minimize their chances of rejection by insurance carriers.

The current employment environment for administrative staff in physician practices reflects the pressures of decreasing provider compensation, rising costs for medical services and for employer and employee medical insurance, increased governmental regulation, increased public awareness of healthcare issues, and increased reimbursement complexity. These elements underpin the changes that occur almost daily in physician/patient relations and related billing/reimbursement issues, so students need to understand this background. They also need to develop the ability to analyze problems, identify the information that is required, research/abstract that information, determine the best course of action, and work in a team to communicate information and share results. Students begin their understanding of the work and the employment environment of medical insurance and billing. 

Student will study the coding of more complex diagnostic and procedural statements. This subject will cover clinical information regarding specific disease processes, more advanced diagnostic and procedural terminology, detailed instruction exploring the CPT book section by section builds upon previous basic knowledge of payer reimbursement guidelines for optimal reimbursement. Understanding how to use the medical record to provide necessary information essential to the assignment of accurate codes will be covered. Students will recognize when multiple coding is required, when it is recommended and when it should not be used. Class room work will involve coding signs and symptoms, V-codes, infectious disease, neoplasm, endocrine, nutritional and metabolic diseases of the blood and blood-forming organs, mental disorders, diseases of the nervous systems and sense organs, circulatory, respiratory, digestive, and genitourinary system as well as diseases of the musculoskeletal system and connective tissue injuries, complications of surgical and medical care, and external causes of injury will be covered.