0048 - Billing and Coding Specialist
Course Description
Billing and Coding Specialist
The skills learned through medical coding certification are essential to hospitals, physicians’ offices, surgery centers, nursing homes, dental offices, home healthcare agencies, mental health facilities and even insurance companies and consulting firms. This rewarding field requires a high level of professionalism and dependability. Tasks performed could include.
I. The Revenue Cycle and Regulatory Compliance
- Revenue Cycle Concepts: Understanding the entire process of a patient encounter from registration to final payment.
- Regulatory Compliance: Adhering to legal, ethical, and regulatory guidelines.
II. Insurance Eligibility and Other Payer Requirements
- Insurance Fundamentals: Understanding different types of insurance plans and payer rules.
- Patient Access and Authorizations: Managing pre-service requirements.
- Patient Financial Responsibility: Understanding patient payment obligations.
III. Coding and Coding Guidelines
- Coding Systems: Applying ICD-10-CM, CPT, and HCPCS Level II coding accurately.
- Abstracting and Reviewing Documentation: Extracting relevant information from medical records.
- Modifiers: Applying appropriate CPT and HCPCS modifiers.
IV. Billing and Reimbursement
- Claim Processing and Submission: Preparing and submitting accurate claims.
- Payment Adjudication and the Explanation of Benefits (EOB): Understanding how claims are paid.
- Denial Management and Appeals: Addressing rejected or unpaid claims.
- Accounts Receivable (A/R) Management and Collections: Managing outstanding balances.
- Reimbursement Principles: Understanding factors affecting payment.
In addition to these core domains, the course will also cover:
- Medical Terminology
- Anatomy and Physiology
- Electronic Health Records (EHR)
- Communication and Customer Service
- Professionalism and Ethics
Prerequisites: While not always mandatory, a basic understanding of medical terminology and computer skills is beneficial. A high school diploma or GED is required to be eligible for the NHA CBCS certification exam.
National Certification: Upon successful completion of this course, students will be prepared to sit for the National Healthcareer Association (NHA) Certified Billing and Coding Specialist (CBCS) certification exam. Achieving the CBCS credential demonstrates competency in medical billing and coding and enhances career opportunities.
Non-credit training programs are designed by a team of professionals from each respective field, providing you with effective face-to-face and web-based learning programs. Instructors/course mentors are actively involved in your learning experience, responding to any questions or concerns, as well as encouraging and motivating you to succeed. The training programs offered through Workforce Development are not part of academic degree programs.