Program Overview

Medical Billing and Coding Program

The Medical Billing and Coding program is designed to train students for an in-demand healthcare career in medical billing and coding, preparing them for industry certification.

Program Description

This comprehensive program introduces key concepts of medical language and human anatomy, emphasizing the interconnectedness of body systems in health and disease. The curriculum covers topics such as the musculoskeletal, cardiovascular, respiratory, nervous, and immune systems, along with mental health and special senses.

Job Outlook

According to the AAPC, medical records specialists without certification earn an average of $61,022 per year, while those with certification see higher earnings, averaging $66,979 annually. The Bureau of Labor Statistics estimates that employment for medical billers and coders is projected to grow by 9% over the next eight years, which is faster than the average for all occupations.

Program Objectives

• Learn how the CPT Category II codes and ICD-10 codes work and how to assign them in common medical billing and coding procedures.
• Be fully prepared to sit for the CPC, CCA, or CBCS exam, offered by the American Academy of Professional Coders.

Prerequisites and Requirements

• There are no prerequisites to take this course.
• This course can be taken on either a PC or Mac.

Instructors

• Nancy Smith: Over 30 years of experience in the healthcare industry, including working as a medical assistant, medical coder, insurance claims specialist, and medical records auditor.
• LaTisha Cottingham: Over 20 years of experience in the healthcare industry, with six years of teaching experience in medical billing and coding.
• Carline Dalgleish: Over 30 years of experience in medical office administration, with a bachelor's degree in Business Information Systems, a master's degree in Leadership, and a post-baccalaureate certificate in Health Information Management.
• Lydia S. Stewart, RN, BSN: Currently serves as the Revenue Cycle Manager at a large regional medical center, with 23 years of experience as a Registered Nurse.
• Bunny Reeves: Senior ambulatory surgery coder at the Maimonides Medical Center in Brooklyn, New York, with experience training student coders.
• Sharon L. Blackford, MA, BA, RMA: Over 30 years of experience in the medical field, with a Master's degree in Organizational Management and a Bachelor's degree in Business Management.
• Stacey O'Brian: More than 10 years of experience in medical coding and reimbursement, with a bachelor's degree from the University of Pittsburgh and a CPC coding certification from the AAPC.

Curriculum Outline

1. Medical Terminology
   • Introduction to Medical Terminology
   • The Musculoskeletal System
   • The Cardiovascular System
   • The Lymphatic and Immune Systems
   • The Respiratory System
   • The Digestive System
   • The Urinary System
   • The Nervous System
   • The Special Senses The Eyes and Ears
   • The Integumentary System
   • The Endocrine System
   • The Reproductive System
   • Diagnostic Procedures, Nuclear Medicine, Pharmacology
2. Medical Billing and Coding
   • Introduction to Medical Billing and Coding
     • Career Opportunities
     • Personal and Technical Qualifications
     • Employment Settings
     • Telecommunications
     • Professional Certifications
   • Introduction to Health Insurance
     • Health Insurance Terminology
     • Commercial and Government Payers
     • Healthcare Documentation
     • Electronic Health Record
   • Managed Healthcare
     • Types of Reimbursement
     • Managed Care Providers
     • Managed Care Models
     • Consumer-Directed Health Plans
   • Revenue Cycle Management
     • Phases of Revenue Cycle Management
     • Encounter Form, Chargemaster
     • Insurance Claim Cycle
     • New Patient Registration
     • Collection Practices
   • Legal Aspects of Health Insurance and Reimbursement
     • Laws Affecting Healthcare
     • Protected Health Information
     • Health Insurance Portability and Accountability Act (HIPAA)
     • Fraud and Abuse in Medical Billing and Coding
     • Release of Information
   • ICD-10-CM Coding
     • Overview of ICD-10-CM
     • Key Features
     • Organization of the Codebook
     • Index to Diseases and Injuries
     • Tabular List of Diseases and Injuries
     • Coding Conventions
     • Official Guidelines
   • CPT Coding
     • Overview of Healthcare Common Procedure Coding System (HCPCS)
     • Category I, Category II, and Category III Codes
     • Organization of the Codebook
     • Main CPT Sections
     • Evaluation and Management
     • Anesthesia
     • Surgery
     • Radiology
     • Pathology and Laboratory
     • Medicine
     • Code Modifiers
   • HCPCS Level II Coding
     • Overview of HCPCS Level II
     • Organization of the Codebook
     • Durable Medical Equipment
   • ICD-10-PCS Coding
     • Overview of ICD-10-PCS
     • Code Structure
     • Definitions
     • Index
     • Code Tables
     • Coding Steps
   • Pharmacology for Coders
     • Pharmacodynamics and Pharmacokinetics
     • Routes of Administration
     • Drug Classifications
     • Prescription Drugs and Over-the-Counter Drugs
     • Controlled Substances
     • Medication Lists and the Electronic Health Record
   • Clinical Documentation Improvement (CDI)
     • Deficiencies in Documentation
     • Medical Necessity
     • Auditing
     • Coding From Patient Documentation
   • Insurance Claims
     • National Uniform Claim Committee
     • CMS-1500 Claim Form
     • Patient and Insured Information
     • Physician or Supplier Information
     • UB-04 Claim Form
   • Commercial Insurance
     • Individual/Group Health Insurance, Automobile, Disability, Liability, Workers' Compensation
     • Completing Commercial Health Insurance Claims
   • Blue Cross Blue Shield
     • History of BCBS
     • Types of BCBS Plans
     • Participating/Nonparticipating Providers
     • BCBS Billing and Payment Guidelines
   • Medicare
     • Medicare Eligibility
     • Medicare Part A, B, C, and D
     • National Coverage Determinations/Local Coverage Determinations
     • Participating/Nonparticipating Providers
     • Physician Fee Schedule
     • Medicare Billing and Payment Guidelines/NCCI
   • Medicaid, CHIP, TRICARE, Workers' Compensation
     • Medicaid
     • Children's Health Insurance Program (CHIP)
     • TRICARE
     • Workers' Compensation
   • Certification
     • Selecting the Right Certification
     • Study Strategies for the Certification Exam
     • Prior to the Exam
     • Morning of the Exam
     • During the Exam
   • How to Find a Job in Medical Billing and Coding
     • Formulating Your Career Goals
     • What Employers Want
     • Showcasing Your Skills
     • Resume Tips
     • Cover Letter Tips
     • Interview Questions

Certification Options

• Certified Professional Coder (CPC) exam offered by the American Academy of Professional Coders (AAPC)
• Certified Coding Associate (CCA) exam offered by the American Health Information Management Association (AHIMA)
• Certified Billing and Coding Specialist (CBCS) exam offered by the National Healthcareer Association (NHA)

Career Opportunities

Medical billing and coding positions are in-demand within medical facilities, health insurance companies, specialty pharmacies, medical suppliers, consulting firms, and national medical coding and billing companies. With the right medical billing and coding training, the opportunities are nearly endless.