Medical Coding and Billing Specialist Certificate Program

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Medical Coding and Billing Specialist

Certificate Program

Delivery Method: Online asynchronous learning with video lectures. Program Hours: 576 hours (2 Modules)

Program Modules: Module I (288 hours)

Section I: Medical Terminology/Anatomy and Physiology (225 hours) Section II: Introduction to Medical Coding (63 hours)

Module II (288 hours)

Section I: Advanced Concepts in Medical Coding (112 hours) Section II: Health Insurance Billing (176 hours)

NOTE: Each Section is divided into a series of lessons we call Study Units (SU). Software Requirements: Microsoft Windows XP, Vista or Windows 7

Microsoft Office 2010

Textbooks:

(Optional) Schroeder, Carol L. Introduction to Medical Terminology, Second Edition Cengage Learning. 2009. ISBN: 9781418030179

Linker, Robin, and Sandra L. Johnson. Understanding Medical Coding: A Comprehensive Guide. Clifton Park, NY: Delmar, 2013.

ISBN: 9781111306809

Moisio, Marie A. A Guide to Health Insurance Billing. Clifton Park, NY: Delmar, 2010. ISBN: 9781435492981

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Prior Knowledge requirements

There are no pre-requisites for this course. Students containing no prior knowledge with Medical Coding and Billing are welcome to enroll. All that the professor expects from a new student is a solid work ethic and eagerness to learn!

Educational Outcome:

Students will receive a Certificate of Completion from ePerceptum for their successful completion of the Medical Coding and Billing Certificate Program. Students will be able to proudly flaunt a verified ePerceptum certificate that is both respected and recognized by leading corporations.

Summary Course Objective:

Upon completion of this course, students will be able to identify, spell, and define all the primary medical terms related to the diagnosis, pathology, and treatment of the major body systems. Students will also be able to correctly code a claim, link the correct Current Procedural Terminology (CPT) and International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for reimbursement, and understand adjustments. In addition, students will find out how and when to bill patients and what to do if there is a denial or rejection. Lastly, students will understand the health insurance industry, identify the foundational skills in medical coding (including ICD-10-CM), demonstrate commonly used insurance claims procedures, and analyze insurance claims from several major health insurance programs.

Course Concepts: Location of Concept:

1. Medical Terminology Study Units 1-15 2. Health and Disease Study Unit 2

3. Skeletal System Study Unit 3

4. Muscular System Study Unit 4

5. Cardiovascular System Study Units 5, 23

6. Lymphatic System Study Unit 6

7. Respiratory System Study Unit 7

8. Digestive System Study Unit 8

9. Urinary System Study Unit 9

10. Nervous System Study Unit 10

11. Eyes and Ears Study Unit 11

12. Integumentary System Study Units 12, 22 13. Endocrine System Study Unit 13 14. Reproductive Systems Study Unit 14 15. Diagnostic Procedures Study Unit 15

16. Medical Coding Study Unit 16

17. ICD-9-CM Study Unit 17

18. HCPCS Level II Study Unit 18

19. Current Procedural Terminology Study Unit 19

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21. Immune System Study Unit 6

22. General Surgery Study Unit 21

23. Anesthesia Study Unit 21

24. Cardiology Study Unit 23

25. OB/GYN Study Unit 24

26. Radiology Study Unit 25

27. Medicine Study Unit 26

28. Laboratory Study Unit 25

29. Insurance Billing Study Unit 28

30. Health Insurance Study Units 29-30

31. ICD-10-CM Study Unit 31

32. Insurance Claim Study Unit 32

33. CMS- 1500 Study Unit 33

34. UB-04 (CMS-1450) Study Unit 34

35. Electronic Data Interchange Study Unit 35 36. Blue Cross/Blue Shield Study Unit 36

37. Medicare Study Unit 37

38. Medicaid Study Unit 38

39. Tricare Study Unit 39

40. Workers' Compensation Study Unit 40

41. Evaluation Study Unit 20

42. Management Study Unit 20

43. Champva Study Unit 39

44. Pathology Study Unit 25

At the conclusion of each study unit, a quiz will be administered and the student must receive a 70% or higher to meet successful completion requirements. Support and mentoring will be available to review material in areas where 70% is not obtained. Students will have 3 attempts to obtain at least a 70%. To receive a Medical Coding and Billing Certificate from ePerceptum, the student must satisfactorily complete the entire training program.

This course will prepare you for your Certified Professional Coder (CPC) medical coding certification. The CPC validates proficiency in the correct application of Current Procedural Terminology, Healthcare Common Procedure Coding System (HCPCS) Level II procedure and supply codes, and ICD-9-CM diagnosis codes used for coding and billing for medical claims in a physician's office.

Module I (288 hours)

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Objective: After completing this section, students will be able to identify, spell, and define all the primary medical terms related to the diagnosis, pathology, and treatment of the major body systems.

Study Unit 1: Introduction to Medical Terminology

Topic A: Introduction Topic B: Word Parts/Roots Topic C: Suffixes/Prefixes Topic D: Pronunciation

Topic E: Spelling/Abbreviations Topic F: Basic Medical Terms Topic G: Career Opportunities Study Unit 1 Quiz

Study Unit 2: The Human Body in Health and Disease

Topic A: Overview/Vocabulary Topic B: Anatomic Reference Systems Topic C: Structures Of Body

Topic D: Cells/Genetics Topic E: Tissues/Glands

Topic F: Body Systems And Related Organs Topic G: Pathology

Topic H: Aging Study Unit 2 Quiz

Study Unit 3: The Skeletal System

Topic A: Overview/Vocabulary

Topic B: Structures And Functions Of Skeletal System Topic C: Structure Of Bones

Topic D: Joints

Topic E: The Skeleton

Topic F: Pathology Of The Skeletal System Topic G: Diagnostic And Treatment Procedures Topic H: Abbreviations

Topic I: Career Opportunities Study Unit 3 Quiz

Study Unit 4: The Muscular System

Topic A: Overview/Vocabulary Topic B: Functions And Structures Topic C: Types Of Muscle Tissues

Topic D: Muscle Contraction And Relaxation Topic E: Contrasting Muscle Motion

Topic F: How Muscles Are Named

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Topic H: Diagnostic And Treatment Procedures Topic I: Abbreviations

Topic J: Career Opportunities Study Unit 4 Quiz

Study Unit 5: The Cardiovascular System

Topic A: Overview/Vocabulary Topic B: Functions And Structures Topic C: Blood Vessels/Blood

Topic D: Pathology Of The Cardiovascular System Topic E: Diagnostic And Treatment Procedures Topic F: Abbreviations

Topic G: Career Opportunities Study Unit 5 Quiz

Study Unit 6: The Lymphatic and Immune Systems

Topic B: Functions And Structures Of Lymphatic System Topic C: Functions And Structures Of Immune System

Study Unit 6: The Lymphatic and Immune Systems continued

Topic D: Pathogenic Organisms Topic E: Oncology

Topic F: Abbreviations

Study Unit 7: The Respiratory System

Topic A: Overview/Vocabulary Topic B: Functions And Structures Topic C: Respiration

Topic D: Pathology Of The Respiration System Topic E: Diagnostic And Treatment Procedures Topic F: Abbreviations

Study Unit 8: The Digestive System

Topic A: Overview/Vocabulary Topic B: Structures

Topic C: Digestion

Topic D: Pathology Of The Digestive System Topic E: Diagnostic And Treatment Procedures Topic F: Abbreviations

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Topic A: Overview/Vocabulary Topic B: Functions And Structures Topic C: The Excretion Of Urine

Topic D: Pathology Of The Urinary System Topic E: Diagnostic And Treatment Procedures Topic F: Abbreviations

Study Unit 10: The Nervous System

Topic A: Overview/Vocabulary Topic B: Functions And Structures Topic C: The Central Nervous System Topic D: The Peripheral Nervous System

Study Unit 10: The Nervous System continued

Topic E: The Autonomic Nervous System Topic F: Pathology Of The Nervous System Topic G: Diagnostic And Treatment Procedures Topic H: Mental Health

Topic I: Abbreviations Topic J: Career Opportunities Study Unit 10 Quiz

Study Unit 11: Special Senses: Eyes and Ears

Topic B: Functions And Structures of Eyes Topic C: Pathology Of The Eyes And Vision

Topic D: Diagnostic And Treatment Procedures Of The Eyes Topic E: Functions And Structures Of Ears

Topic F: Pathology Of The Ears And Hearing

Topic G: Diagnostic And Treatment Procedures Of The Ears Topic H: Diagnostic And Treatment Procedures Of The Ears Topic I: Abbreviations

Topic J: Career Opportunities Study Unit 11 Quiz

Study Unit 12: Skin: The Integumentary System

Topic B: Functions Of The Integumentary System Topic C: Structures Of The Skin

Topic D: Pathology Of The Integumentary System Topic E: Diagnostic And Treatment Procedures Topic F: Abbreviations

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Study Unit 13: The Endocrine System

Topic A: Overview/Vocabulary Topic B: Functions And Structures

Topic C: Pathology Of The Endocrine System Topic D: The Pituitary Gland

Topic E: The Pineal Gland Topic F: The Thyroid Gland Topic G: The Parathyroid Gland Topic H: The Thymus

Topic I: The Pancreatic Islets Topic J: The Adrenal Glands Topic K: The Gonads Topic L: Abbreviations

Study Unit 13: The Endocrine System continued

Topic M: Career Opportunities Study Unit 13 Quiz

Study Unit 14: The Reproductive Systems

Topic B: Functions And Structures Of Male Reproductive System Topic C: Pathology Of Male Reproductive System

Topic D: Diagnostic And Treatment Procedures Of Male Reproductive System Topic E: Sexually Transmitted Diseases

Topic F: Functions And Structures Of Female Reproductive System Topic G: Pathology Of Female Reproductive System

Topic H: Diagnostic And Treatment Procedures Of Female Reproductive System Topic I: Pregnancy And Childbirth

Topic J: Pathology Of Pregnancy And Childbirth Topic K: Assisted Reproduction

Topic L: Abbreviations

Topic M: Career Opportunities Study Unit 14 Quiz

Study Unit 15: Diagnostic Procedures and Pharmacology

Topic B: Basic Examination Procedures and Positions Topic C: Laboratory Tests

Topic D: Endoscopy Topic E: Centesis

Topic F: Imagining Techniques Topic G: Pharmacology Topic H: Medical Technologist Topic I: Abbreviations

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Study Unit 15 Quiz

Section II: Introduction to Medical Coding (63 hours)

Objective: After completing this section, the student will be able to identify, categorize, and interpret ICD-9-CM, as well as recognize the foundational skills to medical coding.

Study Unit 16: Introduction to Coding

Topic A: Career As A Medical Coder Topic B: Skills Required

Topic C: Fraud And Abuse Topic D: Confidentiality

Study Unit 16: Introduction to Coding continued

Topic E: Health Information Technology For Economic And Clinical Health (HITECH)

Topic F: Physician Quality Reporting System (PQRS) Topic G: Electronic Prescribing Incentive Program Topic H: Quality Improvement Organization (QIO) Topic I: Types Of Coding

Topic J: ICD-9-CM Codes Topic K: ICD-10-CM Codes Study Unit 16 Quiz

Study Unit 17: ICD-9-CM

Topic A: History And Usage Of ICD-9-CM Topic B: How To Look Up A Term Topic C: V Codes And E Codes

Topic D: Categories, Subcategories, And Subclassifications Topic E: Coding Conventions

Topic F: Volume 3: Procedural Coding With ICD-9-CM Topic G: Infections

Topic H: Circulatory System Coding Topic I: Diabetes Mellitus

Topic J: Using V Codes Topic K: Obstetrical Coding Topic L: Neoplasms

Topic M: Poisoning Versus Adverse Effects Topic N: Complications And Late Effects Topic O: Official Coding Guidelines Study Unit 17 Quiz

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Topic A: History Of HCPCS Topic B: Format

Topic C: HCPCSII Hierarchy Topic D: Code Revisions

Topic E: HCPCSII Chapter Details Topic F: Accuracy Tips

Topic G: HCPCSII Medication Study Unit 18 Quiz

Study Unit 19: Current Procedural Terminology (CPT) Basics

Topic A: AMA/CPT Code Book Topic B: Symbols

Topic C: Unlisted Codes Topic D: Anesthesia

Study Unit 19: Current Procedural Terminology (CPT) Basics continued

Topic E: CPT Surgical Guidelines Topic F: Medicine Section Topic G: Category I And II Codes Topic H: Online Medical Evaluation Topic I: Tips For Selecting A CPT Code Study Unit 19 Quiz

Module II (288 hours)

Section I: Advanced Concepts in Medical Coding (112 hours)

Objective: After completing this section, students will also be able to correctly code a claim, link the correct CPT and ICD-9-CM codes for reimbursement, and understand adjustments at an advanced level.

Study Unit 20: Evaluation and Management (E/M)

Topic A: AMA/CPT Evaluation And Management Guidelines Topic B: CPT Criteria For Documentation And E/M Code Selection Topic C: Counseling And Coordination Of Care

Topic D: E/M Categories

Topic E: Emergency Department Care

Topic F: 1997 Evaluation And Management Documentation Guidelines Study Unit 20 Quiz

Study Unit 21: Anesthesia and General Surgery

Topic A: Types Of Anesthesia

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Topic C: The Respiratory System Topic D: The Cardiovascular System

Topic E: The Hemic And Lymphatic Systems Topic F: The Digestive System

Topic G: The Urinary System Topic H: The Male Genital System Topic I: Central Nervous System Topic J: The Eye And Ocular Adnexa Topic K: The Auditory System Study Unit 21 Quiz

Study Unit 22: Integumentary System

Topic A: ICD-9-CM Code Selection

Topic B: Evaluation and Management Services

Study Unit 22: Integumentary System continued

Topic C: Surgical Guidelines Topic D: Incision And Drainage Topic E: Debridement

Topic F: Paring Or Cutting Topic G: Removal Of Skin Tags

Topic H: Lesion Removal Or Destruction

Topic I: Intralesional Injections And Tissue Expanders Topic J: Nails

Topic K: Adjacent Tissue Transfer of Rearrangement Topic L: Flaps (Skin And Deep Tissues)

Topic M: Pressure Ulcers (Decubitus Uclers) Topic N: Moh's Micrographic Surgery Topic O: Breast Procedures

Topic P: Repair And Reconstruction Study Unit 22 Quiz

Study Unit 23: Cardiology and the Cardiovascular System

Topic A: Cardiac And Vascular Anatomy And Physiology Topic B: ICD-9-CM Code Selection

Topic C: CPT. 90000 Series Of CPT

Topic D: Intra-cardiac Electrophysiological Procedure/Studies Topic E: Noninvasive Vascular Diagnostic Studies

Topic F: 30000 Series Of CPT Radiology Topic G: Using Modifiers Effectively Topic H: Considering An Unlisted Code Topic I: Category II And Category II Codes Study Unit 23 Quiz

Study Unit 24: Obstetrics and Gynecology (OB/GYN)

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Topic B: Subspecialties Of OB/GYN

Topic C: Anatomy And Physiology Of The Female Reproductive System Topic D: Obstetrics And Gynecology (OB/GYN)

Topic E: Obstetrics (OB) Study Unit 24 Quiz

Study Unit 25: Radiology, Pathology, and Laboratory

Topic A: Radiology Topic B: CPT – Radiology Topic C: Radiology Modifiers Topic D: Diagnostic Radiology Topic E: Diagnostic Ultrasound Topic F: Radiation Oncology Topic G: Nuclear Medicine

Study Unit 25: Radiology, Pathology, and Laboratory continued

Topic H: CPT – Pathology And Laboratory Topic I: Organ Or Disease Oriented Panels Topic J: Evocative/Suppression Testing Topic K: Chemistry

Topic L: Hematology And Coagulation Topic M: Immunology

Topic N: Transfusion Medicine

Topic O: Anatomic Pathology And Cytopathology Topic P: Microbiology

Study Unit 25 Quiz

Study Unit 26: Medicine

Topic A: Medicine Guidelines Topic B: Immune Globulins

Topic C: Immunization Administration Topic D: Vaccines And Toxoids

Topic E: Therapeutic Infusions Topic F: Injections

Topic G: Psychiatry

Topic H: Psychiatric Therapeutic Care Topic I: Biofeedback And Dialysis Topic J: Gastroenterology

Topic K: Otorhinolaryngology Services Topic L: Allergy And Clinical Immunology

Topic M: Neurology And Neuromuscular Procedures Topic N: Central Nervous System Assessments/Tests Topic O: Health And Behavior Assessment

Topic P: Chemotherapy Administration

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Topic R: Physical Medicine And Rehabilitation Topic S: Chiropractic Manipulative Treatment Topic T: Home Health Procedures

Study Unit 26 Quiz

Study Unit 27: Modifiers: A Practical Understanding

Topic A: CPT Modifiers

Topic B: Modifiers Approved For ASC Hospital Outpatient Use Topic C: HCPCS Level II Modifiers

Topic D: NCCI Modifiers Topic E: Category II Modifiers Study Unit 27 Quiz

Section II: Health Insurance Billing (176 hours)

Objective: After completing this section, students will find out how and when to bill patients and what to do if there is a denial or rejection. Students will also understand the health insurance industry, demonstrate commonly used insurance claims procedures, and analyze insurance claims from several major health insurance programs.

Study Unit 28: The Insurance Billing Specialist

Topic A: Key Terms And Overview Topic B: Insurance Billing Specialist Topic C: Employment Opportunities

Topic D: Educational, Certification, And Career Opportunities Topic E: Abbreviations

Study Unit 28 Quiz

Study Unit 29: Legal Aspects of Insurance Billing

Topic A: Key Terms And Overview Topic B: Origin Of Legal Issues Topic C: General Legal Terms Topic D: Confidential Information

Topic E: Insurance Fraud And Abuse Laws Topic F: Abbreviations

Study Unit 29 Quiz

Study Unit 30: Introduction to Health Insurance

Topic A: Key Terms And Overview Topic B: Defining Health Insurance Topic C: Managed Care

Topic D: Managed Care Organizations Topic E: Health Insurance Terminology Topic F: Paying The Bill With Health Insurance

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Topic G: Abbreviations Study Unit 30 Quiz

Study Unit 31: ICD-10-CM

Topic A: Key Terms And Overview Topic B: ICD-10-CM

Topic C: ICD-10-CM Tabular List Conventions Topic D: Assigning ICD-10-CM Diagnosis Codes Topic E: ICD-10-PCS

Topic F: Abbreviations Study Unit 31 Quiz

Study Unit 32: Developing an Insurance Claim

Topic A: Key Terms and Overview Topic B: Patient Registration

Study Unit 32: Developing an Insurance Claim continued

Topic C: Clinical Assessment And Treatment

Topic D: Patient Departure Procedures: New And Established Patients Topic E: Insurance Claim Form: Generation And Submission

Study Unit 33: Common CMS- 1500 Completion Guidelines

Topic A: Key Terms And Overview Topic B: Optical Scanning Guidelines Topic C: CMS-1500 Guidelines

Topic D: CMS-1500 Patient Information

Topic E: CMS-1500 Treatment And Provider Information

Topic F: Common Errors Made When Completing The CMS-1500 Topic G: Abbreviations

Study Unit 33 Quiz

Study Unit 34: Common UB-04 (CMS-1450) Completion Guidelines

Topic A: Key Terms And Overview Topic B: Hospital Reimbursement Topic C: Developing The Insurance Claim Topic D: UB-04 Completion Guidelines Topic E: Submitting The Insurance Claim Topic F: Abbreviations

Study Unit 34 Quiz

Study Unit 35: Electronic Data Interchange

Topic A: Key Terms And Overview

Topic B: Electronic Claims Submission Options Topic C: Completing The Health Insurance Claim

Topic D: Confidentiality And Electronic Claims Processing Topic E: Electronic Record Management

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Study Unit 36: Blue Cross/Blue Shield

Topic B: Blue Cross/Blue Shield Health Insurance Plans Topic C: Participating And Nonparticipating Providers Topic D: Provider Reimbursement

Topic E: CMS-1500 Completion: Blue Cross/Blue Shield Topic F: Abbreviations

Study Unit 36 Quiz

Study Unit 37: Medicare

Topic A: Key Terms and Overview Topic B: Medicare Covered Services

Study Unit 37: Medicare continued

Topic C: Medicare Deductibles And Co-Payments Topic D: Medicare Providers

Topic E: Prescription Drug Benefit Topic F: Medicare Fee Schedule

Topic G: National Correct Coding Initiative Topic H: Medicare Claims Submission Topic I: Processing Medicare Payments Topic J: Abbreviations

Study Unit 37 Quiz

Study Unit 38: Medicaid

Topic A: Key Terms And Overview Topic B: Medicaid Coverage Topic C: Medicaid Billing Topic D: Abbreviations Study Unit 38 Quiz

Study Unit 39: Tricare and Champva

Topic B: TRICARE Health Benefits Programs

Topic C: Participating And Nonparticipating Providers Topic D: Covered And Noncovered Services

Topic E: Durable Medical Equipment (DME) Topic F: TRICARE Billing

Topic G: CHAMPVA Topic H: CHAMPVA Billing

Topic I: CMS-1500 Guidelines For CHAMPVA Topic J: Abbreviations

Study Unit 39 Quiz

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Topic B: Federal Workers' Compensation Programs

Topic C: State-Sponsored Workers' Compensation Programs Topic D: Workers' Compensation Basics

Topic E: Abbreviations Study Unit 40 Quiz