This course is designed to provide you with crucial information that will allow you to become more proficient at collecting money for your office. There are 16 sections. The course begins with basics and progresses into real issues that affect your practice income.

Throughout the course, you will be provided with opportunities to Test Your Knowledge. You will receive instant feedback that will enhance your learning experience and will help you retain more knowledge. Also throughout the course, you will find links that can be clicked on for additional information on a particular topic. After you complete a section, you will be given a section test. As you progress through the course, you will learn about the many intricacies of office billing and practice management.

Upon completion of the last section, you will have the opportunity to take the final exam covering all of the sections you have completed. When you've completed the final exam, you will have received in-depth knowledge of the medical billing process and you will have learned many important procedures and policies you can implement in your office that will help you collect more money.

Below is an overview of the contents of this course:

Office Lingo

In the claims processing and medical billing industry, there are many common words and terms you should become familiar with. It's important for you to understand that misuse of these words or terms will cause your in-experience to show. The best way to ensure that you minimize misuse of words in the beginning, will be to study the words, or terms used most frequently.

Managing Your Office Time

Controlling your time instead of allowing your time to control you is one of the main ingredients in assuring your success as a biller as well as teaching you self-discipline and the ability to control your activities and effectively utilize every minute of your time!

Medical Billing Coding

Universal medical coding systems are used by physicians, insurance payers, other healthcare providers alike to coordinate the payment of specific services for illnesses and injuries. You'll learn how the code books are structured and how to use them to look up codes and their descriptions. Plus, you will learn key factors in determining the use of ICD-10, CPT and HCPCS codes. You'll also learn about modifiers and how to get a discount when purchasing code books annually.

Clearinghouses

You'll learn why clearinghouses are necessary for most offices. We'll answer many common questions such as:

Can I bypass a clearinghouse and submit claims directly to a carrier?

I've heard that BCBS, in some states, will act as a clearinghouse. Can I go that route?

How long does it take to get enrolled with a clearinghouse, and how quickly can I start to send claims?

What factors should I consider when choosing a clearinghouse?

OfficeCollections

Provides examples of how to structure attempts to collect money using a four part series of notices and letters plus we provide links to collection laws by state and we provide you with a link to the Fair Debt Collection Practices Act.

CMS 1500 Claim Form

Refers to every field of the CMS 1500 form and spells out what is required of each field for various billing scenarios, and we provide specifics for Medicare claims.

Insurance Basics

Covers the four basic health care policy categories, three main types of coverage along with other types of coverage, commercial insurance carriers, Medicare, Medicaid, Champus, and Workers Compensation. We explain how to determine when Medicare is the Secondary Payor, MediGap and Medicaid, No-Fault Auto Insurance, Personal Injury and we provide a sample lien form along with a lien release, plus much more.

Explains difference between Medicare Part A and Medicare Part B and provides basics on what is covered and who qualifies for Medicare coverage.

Provides a breakdown of key terms related to managed care.

Explains what should happen in a step by step approach from the time an appointment is made until a claim is paid. We include a discussion on the importance of developing good forms for use in your office, development of fee schedules, pricing and increases to fee schedules, how carriers determine fees, improving a practice's financial results, how various factors affect net income to the practice (doctor pay), controlling overhead, how to analyze where a practice stands financially (with meaningful calculations), what data to review to determine problem areas, what an attainable collection ratio is, how to determine what you're writing off voluntarily, involuntarily and through contractual write offs and how all of this fits into the bigger picture of collecting money for your practice.

Outlines the most common reasons claims are rejected or denied. Offer insight on how to properly appeal rejected or denied claims.

Covers OIG billing guidelines, compliance programs, elements to an effective compliance policy, and the benefits of having a compliance program. Covers the least you need to know about HIPAA Compliance and gives links to some good HIPAA Primers you can review for free.

Provides detailed facts of fraud and abuse along with examples and penalties.

Contains examples of both the CMS 1500 form and the UB92 form. Discusses contracting with third party billers, what to look for in a biller, provides sample confidentiality Statement and the use of this form, gives a sample ethics and conduct form for a medical biller, provides compliance plan issues you must address including reviewing the Government Exclusions database, dealing with credit balances, unclaimed property laws, forgiving deductibles, copays and coinsurance, true hardship cases and how to properly document along with a sample form, what is a false claim and an example of a false claim, developing an office financial policy and the reasons for doing so, provides a sample office policy, gives tips for handling pended and unpaid claims, 15 steps to protect your practice from abusive payment tactics, how to file a health plan complaint through the AMA, provides payment collection scripts for use in your office, discusses records retention and records and hardware destruction and the statute of limitations for collecting a debt for all states.

Average Course Completion time is 40-50 hours.

This Course is pre-approved for 15 CEUs through AMBA