Introduction to Medical Billing and Coding

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Introduction to Medical Billing and Coding
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Introduction to Medical Billing and Coding

• Course Description

• The focus of this course is learning Medical
  Terminology, Anatony and applying them to the
  coding rules and regulations for the CPT,
  ICD-9-CM, and Level II (HCPCS) coding systems and
  then applying the rules to code patient services.
  In addition, a variety of payment systems are
  presented using the Medisoft billing software.
  The medical topics of Medicare fraud/abuse, HMOs,
  PPO, EPO, POS and HIPAA are also reviewed.
•  

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Truman CollegeMedical Billing and CodingCourse
Outline

• Instructional Units

• Unit 1, Medical Terminology
• Unit 2, Human Anatomy Physiology
• Unit 3, Current Procedural Terminology (CPT-4)
  and HCPCS
• Unit 4, International Classification of Diseases,
  9th Revision, Clinical Modification (ICD-9-CM)
• Unit 5, Overview of Medicare, Medicaid and
  Commercial Billing and Reimbursement
• Unit 6, Computerized Medical Billing with
  Medisoft software
•  

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Truman CollegeMedical Billing and CodingCourse
Outline

•  
• Unit 1,
• Medical Terminology

• Medical Terminology is the universal
  communication language of the healthcare
  profession. Terminology for common pathologies
  (diseases) and diagnostic tests is also covered.
  Medical terminology is used in healthcare in
  direct patient care and in support services such
  as coding and medical billing. This course
  focuses on proper pronunciation, usage and
  spelling of medical terms, and is required for
  Medical Billing and Coding students.

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Truman CollegeMedical Billing and CodingCourse
Outline

• Unit 2,
• Human Anatomy Physiology

• A basic understanding of the anatomy and
  physiology of the various body systems is the
  sound foundation upon which all health care
  careers are built, including those providing
  direct patient care and those in support services
  such as coding or medical billling. This course
  examines basic anatomy (structure) and physiology
  (function). Abnormal function (pathology) will be
  discussed briefly as well as the most common
  diagnostic tests used to identify it. This is a
  required course for Medical Billing and Coding
  students.

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Truman CollegeMedical Billing and CodingCourse
Outline

• Unit 3, Fundamentals of Medical Billing and
  Coding
• Current Procedural Terminology (CPT-4)
• HCPCS Coding System

• Identify the purpose of the CPT manual.
• Identify placement of CPT codes on CMS-1500
  insurance form.
• Recognize the symbols used in the CPT manual.
• List the major sections found in the CPT manual.
• Interpret information in section Guidelines and
  notes.
• Apply modifiers.
• Determine when to assign unlisted and Category
  III codes.
• State the purpose and contents of a special
  report.
• Locate terms in the CPT index.
• Identify content of CPT appendices.

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Truman CollegeMedical Billing and CodingCourse
Outline

• Unit 3, Fundamentals of Medical Billing and
  Coding
• Continuation, 2

• Identify and explain the three factors of E/M
  code assignment.
• Analyze the differences among new, established,
  inpatient, and outpatient.
• Explain the levels of E/M service.
• Analyze the key component and contributing
  factors.
• Identify critical elements of Documentation
  Guidelines.
• Define uses of anesthesia.
• Apply anesthesia formula.
• Identify the symbol used in the CPT manual.
• Understand separate procedure designation.
• Analyze the contents of a surgical package.
• Understand what is meant by a surgical tray.
• Distinguish between professional and facility
  services.
• Identify the major factors in wound repair.
• Calculate area and degree of burns.

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Truman CollegeMedical Billing and CodingCourse
Outline

• Unit 3, Fundamentals of Medical Billing and
  Coding
• Continuation, 3

• State the important coding considerations in
  destruction.
• Differentiate among fracture treatments.
• Understand elements of endoscopic procedures.
• Analyze cast application, strapping procedures,
  and traction.
• Differentiate among codes based on the surgical
  approach.
• State the coding rules of arteries and veins.
• Define the critical terms in maternity and
  delivery services.
• Analyze services in the global maternity and
  delivery package.
• Assign E/M codes to services and
  procedures/Medisoft
• Assign Anesthesia codes to services and
  procedures/Medisoft
• Assign Surgery codes to services and
  procedures/Medisoft
• Assign Radiology codes to services and
  procedures/Medisoft
• Assign Pathology and Laboratory codes to services
  and procedures/Medisoft
• Assign Medicine codes to services and
  procedures/Medisoft
• Demonstrate and understanding of radiology
  terminology.
• Analyze the elements of component coding in
  reporting radiology services.
• State the appropriate coding of contrast
  material.
• Understand the use of venipuncture with pathology
  and laboratory services.

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Truman CollegeMedical Billing and CodingCourse
Outline

• Unit 4, Coding Applications
• International Classification of Diseases, 9th
  Revision, Clinical Modification (ICD-9-CM)

• List the uses of the ICD-9-CM.
• Explain ICD-9-CM coding conventions.
• Identify the characteristics of ICD-9-CM Volume
  2.
• Identify the characteristics of ICD-9-CM Volume
  1.
• Identify the characteristics of ICD-9-CM Volume
  3.
• List the developers of the ICD-9-CM Official
  Coding Guidelines.
• Understand the application of the ICD-9-CM
  Official Coding Guidelines.
• Define the steps to ICD-9-CM diagnosis coding.
• Assign ICD-9-CM codes to various diagnosis
  statements.
• Understand the format of the ICD-10-CM.
• Distinguish between Medicare Parts A, B, and C.
• Define participating provider.
• Locate information in the Federal Register.
• Explain the RBRVS system.
• State the structure of the APC system.
• Understand the framework of Medicare Fraud and
  Abuse.
• Identify the major components of Managed Health
  Care.

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Truman CollegeMedical Billing and CodingCourse
Outline

• Unit 5,
• Overview of Medicare, Medicaid and Commercial
  Billing and Reimbursement

• Distinguish between Medicare Parts A, B, and C.
• Define participating provider.
• Locate information in the Federal Register.
• Explain the RBRVS system.
• State the structure of the APC system.
• Understand the framework of Medicare Fraud and
  Abuse.
• Identify the major components of Managed Health
  Care.

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Truman CollegeMedical Billing and CodingCourse
Outline

• Unit 6,
• Computerized Medical Billing with Medisoft
  software

• This course will allow you to acquire hands-on
  practice with Medisoft, the country's most
  popular health care billing software. Learn how
  to complete inpatient information, and learn the
  scheduling, billing, and electronic filing
  features of Medisoft through computer
  simulations.  Prerequisites Completion of Intro
  to Microcomputers and Keyboarding (or equivalent
  training or experience), Human Anatomy and
  Physiology, Medical Terminology, Fundamentals of
  Medical Billing and Coding, and Coding
  Applications.

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Truman CollegeMedical Billing and Coding

• Certification for AHIMA
• CCA-CCS

• AHIMA recognizes that the demand for coders has
  never been greaterand this need is expected to
  continue for some years to come. By creating an
  entry-level coding credential based on job
  analysis standards and state-of-the-art test
  construction, AHIMA aims to increase the number
  of qualified new coders who earn the CCA will
  immediately demonstrate their competency in the
  field, even if they don't have much job
  experience. Earning a CCA demonstrates a
  commitment to coding even for those who are new
  in the field. CCA holders will also distinguish
  themselves from non-credentialed coders and those
  who hold credentials from other organizations
  that do not require the higher level of expertise
  necessary to earn AHIMA certification.
• The CCA should be viewed as the starting point
  for an individual entering a new career as a
  coder. The CCS and/or CCS-P exams demonstrate the
  mastery level skills that the CCA would strive
  for to advance his or her career.
• To ensure that its members meet professional
  standards of excellence, AHIMA issues credentials
  in health information management, coding, and
  healthcare privacy and security. Members earn
  credentials through a combination of education
  and experience, and finally performance on
  national certification exams. Following their
  initial certification, AHIMA members must
  maintain their credentials and thereby the
  highest level of competency for their employers
  and consumers through rigorous continuing
  education requirements.
• Coding
• Certified Coding Associate (CCA)
• Certified Coding Specialist (CCS)
• Certified Coding Specialist-Physician-based
  (CCS-P)
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Truman CollegeMedical Billing and Coding

• Certification for AAPC
• CPC

• A Certified Professional Coder (CPC) is an
  individual of high professional integrity who has
  passed a coding certification examination
  sponsored by the American Academy of Professional
  Coders (the AAPC). The examination consists of
  questions regarding the correct application of
  CPT, HCPCS procedure and supply codes and
  ICD-9-CM diagnosis codes used for billing
  professional medical services to insurance
  companies. A CPC must have at least two years
  coding experience and maintain yearly renewal as
  well as submit Continuing Education Units (CEUs)
  every two years. A CPC is an individual who in
  addition to on the job experience as a coder has
  achieved a measurable level of knowledge and
  expertise in reviewing and adjudicating coding of
  services, procedures and diagnoses on medical
  claims.

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Truman CollegeMedical Billing and Coding

• Salary 2006

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Truman CollegeMedical Billing and Coding

• Working Conditions
•  
• Medical Billing and Coding Employees usually work
  
• 40-hours a week- days, and evening shifts some
  overtime may be required.

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Truman CollegeMedical Billing and Coding

• Employment
• Physicians' offices Outpatient Clinics,
  Ambulatory Surgery Centers
• Hospitals, Public Health Departments, and Medical
  Centers
• Medical Insurance Companies

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Truman CollegeMedical Billing and Coding

• Job Outlook
•  
• Prospects should be very good Medical Billers
  and Medical Coders are expected to grow much
  faster than average
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Truman CollegeMedical Billing and CodingCourse
Outline

• Summarize Training
•  
• Truman College's six-course program will prepare
  you for an entry-level position and you will gain
  valuable hands-on experience with current
  industry software.
• Human Anatomy and Physiology, Medical Terminology
  for Healthcare Professions, Fundamentals of
  Medical Billing and Coding, Coding Applications,
  Medicare, Medicaid, and Commercial Billing,
  Computerized Medical Billing and Coding also the
  legal aspects of health information coding data.
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Questions on Medical Billing and Coding
Continuing Education Program