Course Outline

Medical Coding and Billing Your Course Code is

Course Objectives 5563
Upon completion of this course, graduates will be trained to:
•  escribe the roles, average day, personal qualities and desirable character traits of various healthcare professionals.
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• Demonstrate professionalism through acceptable attitude, organization and time management skills, and attire as appropriate to a healthcare setting.
• Employ legal and ethical standards related to patient confidentiality within the healthcare community environment.
• Define terms showing a fundamental understanding of the human body and medical terminology as they apply to medical billing and coding.
• Describe the history and development, organization and use of various diagnostic and procedural manuals and how they apply to insurance.
• Describe the characteristics of the types of healthcare insurance and explain the differences between them.
• Appropriately perform medical claims submissions applying standard payment methodologies and forms.
• Explain the terms used to describe parts of a medical record and explanation of benefits.
• Apply industry-standard payment methodologies to complete forms for primary and secondary insurance and create medical bills for patients.
• Use verbal, non-verbal and written communications skills demonstrating an understanding of theory and practical skills to perform medical billing
and coding tasks in a healthcare setting.
• Classify and assign diagnostic and procedure codes to medical records using ICD-10-CM and CPT coding systems as used in a variety of settings.

UNIT 1 Lesson 7: Medical Shorthand Lesson 13: Private Insurance and Managed Care
Practice writing common medical abbreviations, slang and symbols that Gain an overview of the characteristics of private and group healthcare
Lesson 1: The World of Health Care are used in health care and learn which medical shorthand to avoid. insurance programs. Discover the details of private health insurance,
In your first lesson, examine the average day of various healthcare Discover how acronyms, eponyms and brand names are written in the as well as self-funded insurance plans and third-party administrators.
professionals, and discover the responsibilities of each. Learn about the medical industry. Explore frequently used and misspelled antonyms and Examine managed care programs and how they work, including
team of professionals that provide quality health care. Finally, explore sound-alike words found in the medical field. discussions of HMOs, PPOs, POS plans and PPGs. Explore health
the personal qualities and desirable character traits of a successful savings accounts, learning why they exist and how to bill them.
healthcare professional.
Quiz 7
This quiz is worth 1 percent of your course grade. Quiz 13
Quiz 1 This quiz is worth 2 percent of your course grade.
This quiz is worth 1 percent of your course grade. Lesson 8: Ethics and Legal Issues
Healthcare professionals must adhere to some important legal Lesson 14: Medicaid, PACE, CHIP and Medicare
Lesson 2: Medical Insurance 101 and ethical guidelines. This lesson explains the concepts of ethics, Discover the government programs of Medicaid and Medicare, including
This lesson is an introduction to medical insurance. Learn insurance compliance, fraud and abuse. Determine how these concepts apply the covered services and when preauthorization’s might be needed.
terminology, such as deductible, copayment and visitation limits. to your future career. Study HIPAA as it relates to protecting health Learn about Medigap and Medi-Medi insurance, as well as gain an
Examine the claim forms used for inpatient and outpatient claims, before information, and the importance of confidentiality when dealing with overview of the Children’s Health Insurance Program and the Program of
looking at the basics of the coding manuals. Explore the life cycle of a medical records. Learn about recovery audit contractors, liability, All-Inclusive Care for the Elderly. With Medicare, discover the benefits of
medical bill and learn the importance of accuracy and being thorough. subpoenas, arbitration and medical testimony. being a participating provider and when an advance beneficiary notice
Then, learn the basics of the various types of health care, including is required. Explore the details of Medicare Parts A and B, and briefly
Medicare, Medicaid, TRICARE, workers’ compensation, private health
Quiz 8—Trigger Quiz
look at the Medicare Advantage and prescription plans.
care and managed care. This quiz is worth 2 percent of your course grade.
Quiz 14
Quiz 2 Lesson 9: Body Systems, Part 1 This quiz is worth 2 percent of your course grade.
This quiz is worth 1 percent of your course grade. Learn the basics of organs and organ systems while expanding and
applying your knowledge of medical terms and abbreviations. In this Lesson 15: Military Insurance, Workers’
Lesson 3: Medical Records lesson, learn about the integumentary, musculoskeletal, neurological Compensation and COBRA
This lesson outlines the role medical records play in healthcare and cardiovascular systems, as well as study the lymphatic and immune Learn terminology related to TRICARE, as well as the services
documentation. Discover the elements of the various forms included systems. covered and types of coverage available. After briefly learning about
in the medical record, and learn the importance of documentation, as
well as the different formats. Examine the documentation guidelines
Quiz 9 CHAMPVA, examine the identification card for the military. Focus on
workers’ compensation by learning the different types of coverage and
and good record keeping practices, including the process of correcting This quiz is worth 1 percent of your course grade. classifications of injuries. After learning about disability insurance, wrap
written and electronic records.
Lesson 10: Body Systems, Part 2 up the lesson by learning about COBRA, which is insurance for those
Quiz 3 Continue with the body systems and learn the basics of organs and
that lose their jobs.
This quiz is worth 1 percent of your course grade. organ systems in this lesson. In addition, apply your knowledge Quiz 15
of medical terms and abbreviations related to the respiratory, This quiz is worth 2 percent of your course grade.
Lesson 4: Electronic Records gastrointestinal, genitourinary and endocrine systems.
Gain a basic understanding of electronic records. Begin with a history
Quiz 10 Lesson 16: Introducing the CMS-1500 Claim Form
by learning the core functions that a computer-based patient record Perform the work of a medical billing specialist! Detailed explanations
should be capable of performing. Then, look to the future goals, This quiz is worth 1 percent of your course grade. help you complete the fields of the CMS-1500 insurance claim form and
including interoperability with standards and controlled vocabulary. determine special considerations for Medicare, Medicaid, TRICARE and
Wrap up the lesson by learning about the hybrid system, known as the workers’ compensation. This lesson offers plenty of hands-on practice in
electronic data management system. UNIT 2 completing claim forms.
Quiz 4 Lesson 11: Reimbursement Quiz 16
This quiz is worth 1 percent of your course grade. Learn the history of healthcare reimbursement, as well as the This quiz is worth 5 percent of your course grade.
development of government and private insurance companies. Discover
Lesson 5: Introduction to Medical Terminology how the Affordable Care Act has affected insurance reimbursement. Lesson 17: Explanation of Benefits
Begin to master medical terminology with a simple, word-building Explore the physician quality reporting system and quality payment Explore the terms found on the explanation of benefits and electronic
system. Discover how to pronounce and spell common medical root program. remittance advice. Discover some common reasons for claim denials
words. Explore common prefixes and suffixes used with medical terms. and learn how to avoid denials. Learn to read and interpret the
Learn how prefixes and suffixes can change the meaning of the medical Quiz 11
explanations of benefits that come from various insurance carriers. This
term in this lesson. This quiz is worth 2 percent of your course grade. lesson also contains extensive, hands-on practice with the CMS-1500
Quiz 5 Lesson 12: Coding for the Medical Biller for various carriers.
This quiz is worth 1 percent of your course grade. Learn the history and development of the various coding systems, Quiz 17
Lesson 6: Dividing and Combining Medical Terms including the ICD-10-CM, ICD-10-PCS, CPT and HCPCS. Examine the This quiz is worth 5 percent of your course grade.
basics of the contents of each manual and learn how to identify the
This lesson continues your study of the language of medicine. Learn to code types. Discover the general rules for sequencing procedural Lesson 18: Secondary Claims
divide medical words into word parts to determine meanings, as well as codes. Learn that the coordination of benefits determines coverage with more
combine those parts to form medical terms. than one insurance carrier. Examine the process of preparing secondary
Quiz 12
Quiz 6 claims and handle insurance logs. Hands-on practice reviewing
This quiz is worth 2 percent of your course grade. explanation of benefits and completing claims for secondary carriers is
This quiz is worth 1 percent of your course grade.
also available.
Quiz 18
Affiliations & Partnerships This quiz is worth 5 percent of your course grade.

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Lesson 19: Insurance Basics Lesson 28: ICD-10-CM Chapters 11, 12 and 13 Lesson 35: Radiology, Pathology, Anesthesia and
Discover the reimbursement systems developed to deal with the rising Explore diseases of the digestive system, and review the anatomy of Medicine
healthcare insurance costs, such as the prospective payment system, the skin and subcutaneous tissue, while learning how to apply accurate This lesson teaches radiology terms, subsections and guidelines, as well
resource-based relative value scale, the national correct coding diagnostic codes. Examine the musculoskeletal system, as well as how as coding for radiology procedures. Guidelines and coding information
initiative, ambulatory payment classifications and status indicators. to code related diagnoses. for pathology and anesthesia are included, too. Examine the medicine
Learn about timely filing and the specifics of Medicaid, Medicare and Quiz 28 section of the CPT.
TRICARE. Explore the additional forms needed for TRICARE claims, and
the benefit of accepting assignment. Examine the forms needed for a This quiz is worth 2 percent of your course grade. Quiz 35
workers’ compensation claim, and get hands-on practice completing This quiz is worth 2 percent of your course grade.
the claim. Discover how to manage patient accounts by keeping an Lesson 29: ICD-10-CM Chapters 14 through 17
insurance log. Learn how to deal with insurance problems, including Study the diagnosis coding of the genitourinary system. Explore the Lesson 36: Integrating Diagnostic and Procedural
sending tracers, filing narrative explanations and appeals. process of assigning codes to conditions found in pregnancy, childbirth Codes
Quiz 19—Trigger Quiz and the puerperium, as well as those conditions originating in the
perinatal period. Assess congenital malformations, deformations and Now, you have a chance to apply all of the medical coding knowledge
This quiz is worth 3 percent of your course grade. chromosomal abnormalities while learning how to determine the that you’ve gained so far! Code diagnoses and procedures together to
correct diagnosis code. With each ICD-10-CM chapter, learn about the work through real-world healthcare situations.
Lesson 20: Denials and Aging terminology related to the conditions. Quiz 36
Discover the types and benefits of electronic claims, as you learn how Quiz 29—Trigger Quiz This quiz is worth 5 percent of your course grade.
a clean claim speeds up the reimbursement process. Explore additional
causes of denials and learn how to work aging reports to collect all This quiz is worth 5 percent of your course grade.
funds due to the provider. Examine the process of underpayments
and how to identify when it’s happening to you. After learning how to Lesson 30: ICD-10-CM Chapters 18 and 19 UNIT 5
increase the likelihood of getting patients to pay and the collection Study the terminology related to symptoms, signs and abnormal clinical
process, discover what triggers retrospective audits and what to do if and laboratory findings. Assess and code for injuries, poisonings and Lesson 37: Components of Evaluation and
your practice is audited. certain other consequences of external causes. Management Services
Quiz 20 Quiz 30 This lesson introduces the components of evaluation and management
codes, an important area for outpatient coders. Explore guidelines, and
This quiz is worth 2 percent of your course grade. This quiz is worth 2 percent of your course grade. begin to understand evaluation and management level selections.
Lesson 21: Medical Billing Technology Lesson 31: ICD-10-CM Chapters 20, 21 and 22 Quiz 37
Discover the evolving technology of medical billing with hands-on Learn the terminology related to external causes of morbidity and the This quiz is worth 2 percent of your course grade.
practice completing claims using medical billing software. Learn how process of coding these circumstances. Explore the factors influencing
to add new patients to the software, assign primary and secondary health status and contact with health services. Examine the chapter of Lesson 38: Evaluation and Management Services
insurance and create a claim. Examine the process of posting the ICD-10-CM developed for the provisional assignment of new diseases Take a closer look at the Evaluation and Management sections.
payments, from both the insurance company and the patient. Explore on uncertain etiology or emergency use. This lesson allows you to apply This lesson provides plenty of practice with coding Evaluation and
the process of creating a bill to send to the patient for outstanding your diagnostic coding knowledge to real-world scenarios. Management services!
balances, and how to process claims for those without insurance. Quiz 31 Quiz 38
Quiz 21 This quiz is worth 5 percent of your course grade. This quiz is worth 5 percent of your course grade.
This quiz is worth 5 percent of your course grade.
Lesson 39: Final Coding Quiz
UNIT 4 Use this Final Coding Quiz as an opportunity to apply your new coding
UNIT 3 skills for both diagnostic and procedural codes.
Lesson 32: Procedural Coding 101 Quiz 39
Lesson 22: Introduction to Anatomy With diagnostic coding under your belt, move on to the history of
Knowledge of anatomy and physiology is crucial to anyone who works procedural coding. Understand the structure and format of the CPT This quiz is worth 6 percent of your course grade.
in medicine. Explain the relationships among anatomy, physiology and coding manual, as well as the basic steps of CPT coding. Gain an
pathology. Discover how the human body is put together and how it introduction to HCPCS coding. Discover the formats, coding rules and
works. how to determine when to use HCPCS codes.
Quiz 22 Quiz 32
This quiz is worth 1 percent of your course grade. This quiz is worth 2 percent of your course grade.
Lesson 23: Anatomy: Landmarks and Divisions Lesson 33: Surgical Coding, Part 1 GRADING CRITERIA
This lesson delves deeper into anatomy! Explore landmarks and Discover how to code procedures related to the integumentary,
divisions, as well as the basic body cavities and how the body is musculoskeletal, digestive and urinary systems. Code for conditions 92-100% = A
organized physiologically. Gain a basic understanding of each body found in the respiratory, cardiovascular, hemic and lymphatic systems,
system. as well as the mediastinum and diaphragm.
85-91% = B
Quiz 23 Quiz 33 75-84% = C
This quiz is worth 1 percent of your course grade. This quiz is worth 4 percent of your course grade. 70-74% = D
Below 70% = F
Lesson 24: Cell and Tissue Anatomy and Pathology Lesson 34: Surgical Coding, Part 2
Review the components of the cell and the primary functions of each The male and female reproductive systems are outlined in this lesson.
If you plan to work independently, your grades
component. Differentiate among the categories of etiologies, and study Code maternity and childbirth procedures, as well as procedures related should consistently be above 85%. If your grades are
how cells and the human body respond and react to injury. Learn to to the endocrine, nervous, visual and auditory systems. 84% or below, you will need to make improvements
pronounce and write pathological and etiological terms. Explore how Quiz 34—Trigger Quiz to bring your skills to an employable level.
tissue responds to injury in this lesson.
This quiz is worth 2 percent of your course grade.
Quiz 24 Your final grade point average will be calculated
on all graded assignments in this course. You must
This quiz is worth 1 percent of your course grade.
Graduation Gift complete all assignments and attain a final grade
Lesson 25: Introduction to ICD-10-CM and Chapter 1 National Healthcareer Association (NHA) point average of 70% or higher to earn a certificate.
Explore the structure of the ICD-10-CM and the purpose of the guidelines
and rules of the diagnostic coding process. Determine how to handle CBCS Study Guide, Practice Test and Exam
abbreviations, cross-references and punctuation. In addition, start the Application reimbursement
coding process by learning about infections, as well as how to code
them. To request your gifts, simply call Coding Manuals
Quiz 25
This quiz is worth 2 percent of your course grade. 1-800-347-7899 • ICD-10-CM Manual*
Lesson 26: ICD-10-CM Chapters 2 through 5 or email [email protected] • CPT Manual**
Study terminology related to neoplasms, as well as diseases of the — Must have graduated and be paid in full —
blood and blood-forming organs and certain disorders of the immune *Shipped upon completion of Quiz 19
We reserve the right to substitute items of equal or greater value.
mechanism. Examine endocrine, nutritional and metabolic diseases. Offer limited to one (1) year after graduation. **Shipped upon completion of Quiz 29
Practice coding the diseases and disorders found in Chapters 2 through
5 of the ICD-10-CM.
Quiz 26
This quiz is worth 2 percent of your course grade. Career Starter Guide
Lesson 27: ICD-10-CM Chapters 6 through 10
Get more practice with diagnostic coding as you explore mental,
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respiratory systems.
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Quiz 27 for yourself...how to write a letter
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