Independent Biller Solutions Course Outline

Chapter 1
Lesson 1. Introduction to Medical Billing. What is a Medical Bill?. Life Cycle of a Medical Bill Processing the Bill The Importance of Being Accurate and Thorough. Lesson 1 Review..	Lesson 2. The Daily Medical Office Professional Routine. Medical Claims Specialists Daily Routine: The Old Paper Method.	Lesson 3. How Insurance Works. Medical Insurance. Insurance Terminology. Co-payment Reasonable and Customary. Explanation of Benefits. Types of Health Insurance. Government Insurance Programs. Private Insurance Companies - Traditional and Managed Care.	Lesson 4. Pre-authorization Requirements. Diagnostic Codes. CPT Procedure Code Divisions. Practice Test 1.

Chapter 2
Starting an at Home Office. Confidentiality. Continuing Education. Professional Societies.	Lesson 5. Diagnostic Coding. Using the ICD-9-CM... Coding ICD-9. The Five Steps to Diagnostic Coding. Instruction on E & V Codes. Coding Concepts. Unconfirmed Diagnoses. Acute vs. Chronic & Congenital vs. Acquired Conditions. Late Effects Coding. Coding for Burns. Specific Coding Situations. Pregnancy.	Lesson 6. Procedure Coding. The organization of the CPT book. Divisions of Sections. Evaluation and Management Common CPT Terms. Using the CPT Code Book: Coding Examples. Procedure Coding Concepts. Surgical Concepts. Bundling or Packaging. Modifiers. Relative Value Studies. Methods of Payment Fee Schedules. Usual, Customary and Reasonable. Practice Test 2 - Chapter 2.

Chapter 3
Lesson 7. About the DRG System.. Utilization Review.. Peer Review Organizations. The DRG Monitor Handling DRG’s as a Medical Claims and Billing Specialist	Lesson 8. Government Insurance Programs. Medicaid. Who is eligible for Medicaid?. Services Covered by Medicaid. Facts About Medicaid -- Some Additional Services. The Claim Form.. Explanation of Benefits. The Medicaid Identification Cards. Pre-authorization. Time Limits And Appeals. Reciprocity. When A Person Has Other Insurance. Medicare. Medicare Part A.. Medicare Part B.. Participating Physicians. Filing A Medicare Claim.. Fiscal Agents. The Medicare Identification Card. Physician Identification Numbers. Supplements To Medicare Insurance. Facts About Medicare As a Supplemental Carrier	Lesson 9. CHAMPVA and CHAMPUS. Coverage of CHAMPUS and CHAMPVA.. Filing CHAMPUS and CHAMPVA claims. The Non availability Statement Filing Claims. Claims for Physicians Who HAVE Accepted Assignment Claims for Physicians Who Have NOT Accepted Assignment Before You File a Claim.. The Claim Form.. TRICARE. Worker's Compensation. Filing a Worker's Compensation Claim.. Facts About Filing a Worker's Compensation Claim.. A Note About Patient Records. Disability Insurance. Practice Test 3 (Lessons 7 - 10)

Chapter 4	Chapter 5	Chapter 6
Lesson 10 Blue Cross. Blue Shield. The Blue Cross and Blue Shield Association. Facts About Blue Cross and Blue Shield. Reciprocity. Future of Blue Cross and Blue Shield. Quiz 4 – Chapter 4.	Lesson 11. Introduction to Electronic Claims. Clearinghouses. Working with Electronic Claims. Using the Computer to Complete a Claim.. Setting Up An Electronic Claims Contract Managing Records. Facts About Keeping Records. Confidentiality. Quiz 5 - Chapter 5.	Lesson 12. Step 1: Read this Lesson Preview.. Carrier Section. Completing the CMS-1500 Form.. Proofreading and Processing the CMS-1500 Form..