Medical Billing and Coding

Schedule: Coursework available 24/7

Total Course Hours: 755

Estimated Completion Time: 

• Students who commit 20 hours/week can complete in 38 weeks.
• Students who commit 15 hours/week can complete in 50 weeks.

Maximum time to complete: Students have access to the online course materials for 12 months.

• Self-directed study
• Skills demonstrations and online activities to aid learning
• Quizzes and Exams

• Buck’s 2023 HCPCS Level II (Physical Book)

• Buck’s 2023 ICD-10-CM for Hospitals (Physical Book)  

• Buck’s Step-by-Step Medical Coding, 2023 Edition (eBook) 

• Buck’s Workbook for Step-by-Step Medical Coding, 2023 Edition (eBook) 

• CPT 2023 Professional Edition (Physical Book) 

• FA Davis eBook / Lab Integration: Medical Terminology Systems (eBook) 

• Fordney’s Medical Insurance 16th Edition (eBook) 

• Software: SimChart for the Medical Office

• Workbook for Fordney’s Medical Insurance 16th Edition (eBook) 

Textbooks are included in the cost of tuition

Medical Billing Career Prep Curriculum:

• Module 1: Role of the Insurance Billing Specialist
• Module 2: Compliance, Privacy, Fraud, and Abuse in Insurance Billing
• Module 3: Basics of Health Insurance
• Module 4: The Blue Plans, Private Insurance, & Managed Health Care Plans
• Module 5: Medicare, Medicaid, & Other State Programs
• Module 6: TRICARE & Veterans Health Care
• Module 7: Workers’ Compensation
• Module 8: Disability Income Insurance & Disability Benefit Programs
• Module 9: Medical Documentation & Electronic Health Records
• Module 10: Diagnostic Coding
• Module 11: Procedural Coding
• Module 12: The Paper Claim (CMS-1500)
• Module 13: The Electronic Claim
• Module 14: Receiving Payments & Insurance Problem Solving
• Module 15: Collection Strategies
• Module 16: Ambulatory Surgery Centers
• Module 17: Hospital Outpatient & Inpatient Billing
• Module 18: Seeking a Job and Attaining Professional Advancement

Medical Coding Career Prep Curriculum:

• Module 1: Reimbursement, HIPAA, and Compliance
• Module 2: An Overview of ICD-10-CM
• Module 3: ICD-10-CM Outpatient Coding and Reporting Guidelines
• Module 4: Using ICD-10-CM
• Module 5: Chapter-Specific Guidelines (ICD-10-CM Chapters 1-10)
• Module 6: Chapter-Specific Guidelines (ICD-10-CM Chapters 11-14)
• Module 7: Chapter-Specific Guidelines (ICD-10-CM Chapters 15-21)
• Module 8: Introduction to CPT and the Level II National Codes (HCPCS)
• Module 9: Modifiers
• Module 10: Evaluation and Management (E/M) Services
• Module 11: Anesthesia
• Module 12: Surgery Guidelines and General Surgery
• Module 13: Integumentary System
• Module 14: Musculoskeletal System
• Module 15: Respiratory System
• Module 16: Cardiovascular System
• Module 17: Hemic, Lymphatic, Mediastinum, and Diaphragm
• Module 18: Digestive System
• Module 19: Urinary and Male Genital Systems
• Module 20: Reproductive, Intersex Surgery, Female Genital System, and Maternity Care and Delivery
• Module 21: Endocrine and Nervous Systems
• Module 22: Eye, Ocular Adnexa, Auditory, and Operating Microscope
• Module 23: Radiology
• Module 24: Pathology/Laboratory
• Module 25: Medicine
• Module 26: Inpatient Coding

Medical Terminology Career Prep Curriculum:

• Module 1: Introduction to Medical Terminology
• Module 2: Skeletal and Muscular System
• Module 3: Cardiovascular System
• Module 4: Lymphatic and Immune System
• Module 5: Respiratory System
• Module 6: Digestive System
• Module 7: Urinary System
• Module 8: Nervous Systems and Special Senses, Eyes and Ears
• Module 9: Integumentary System
• Module 10: Endocrine System
• Module 11: Reproductive System
• Module 12: Diagnostic Procedures, Nuclear Medicine, and Pharmacology

• Define the role of an insurance billing specialist, responsibilities and tasks, customer-focused service, career advantages, job search techniques, necessary qualifications, and pathways to certification.
• Compare and contrast the Health Insurance Portability and Accountability Act (HIPAA), insurance reforms, HITECH Act, health insurance, the Patient Protection and Affordable Care Act, traditional indemnity, and managed care plans.
• Describe the differences between the eligibility, benefits, and claim submission for Medicare, Medicaid, and other state programs, TRICARE and Veteran’s Health Care, workers’ compensation, employers’ liability insurance, individual and group disability income insurance
• Explain the importance of medical records and proper diagnoses and procedural coding.
• List the steps in the administrative life cycle of a physician-based insurance claim.
• Describe the differences between paper and electronic claim submission.
• Understand the cash flow cycle in the medical office and payments by insurance and patients.
• Describe third-party reimbursement issues.
• Utilize the ICD-10-CM and the GEMs file, the Alphabetic Index, and the Tabular List to map codes.
• Understand the ICD-10-CM Outpatient Coding and Reporting Guidelines, General Coding Guidelines to assign codes.
• Apply ICD-10-CM Official Guidelines for Coding and Reporting of infectious diseases, neoplasms, endocrine, nutritional, and metabolic diseases, and immunity disorders, diseases of blood and blood-forming organs, mental disorders, diseases of the nervous system and sense organs, diseases of the circulatory system, and diseases of the respiratory system.
• Apply ICD-10-CM Official Guidelines for Coding and Reporting of diseases of the digestive system, diseases of the skin and subcutaneous tissue, disease of the musculoskeletal system and connective tissues.
• Apply ICD-10-CM Official Guidelines for Coding and Reporting of diseases of the pregnancy, childbirth, and the puerperium, certain conditions originating in the perinatal period, congenital malformations, deformations, and chromosomal abnormalities, symptoms signs and abnormal clinical and laboratory findings, not elsewhere classified, and injury and poisoning, and certain other consequences of external causes.
• Properly use the CPT manual and categories of CPT codes, including proper use of modifiers to indicate delivery of services in nonstandard ways.
• Properly code procedures and services from the Evaluation and Management (E/M) section of the CPT.
• List the methods of sedation and the formula used to determine to code for anesthesia services.
• Locate the notes and guidelines and code procedures and services in the Surgery section, state the use of unlisted procedures, interpret elements of a special report, examine the designation of separate procedures, analyze contents of a surgical package, and determine the contents of the General Subsection.
• Code procedures and services related to the CPT subsections on the Integumentary System, Musculoskeletal System, Respiratory System Cardiovascular System, Hemic and Lymphatic Systems and the Mediastinum and Diaphragm, Digestive System, Urinary and Male Genital Systems, Reproductive System, Intersex Surgeries, and also those that affect the Female Genital System, Endocrine and Nervous systems, the eye, ocular adnexa, and auditory system.
• Code services associated with radiology services and in the Medicine section of the CPT manual.
• Code and report Inpatient services and differentiate between inpatient and outpatient coding.
• Identify the four-word elements used to build medical words, divide medical words into their component parts, and apply the basic rules to define and build medical words.