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Introduction to Medical Billing

By GinaUpdated 1 min read

The reimbursement cycle

Claim paid Refused — appeal it

STAGE 01Verifyeligibility, benefits, cooSTAGE 02Code encounterICD-10 diagnosis, CPT and STAGE 03Charge entrythe superbill becomes charSTAGE 04Submit claimCMS-1500, or the 837 electSTAGE 05Adjudicationthe payer decidesSTAGE 06Post paymentread the ERA or EOB and poSTAGE 07Patient balancestatement, then accounts r Refused → appeal
The seven stages of the medical billing reimbursement cycle, with denied claims looping back through appeal to resubmission.

Medical Billing 101

Below are the links to each topic of our introduction to medical billing lesson. This is an abbreviated summary of our more extensive Fundamentals of Medical Billing Course in which we cover these topics in much more detail as well as provide a hard-copy of each topic along with the all the essential forms.

Each of the topics below includes a short video explaining the particular topic.

A detailed outline of the complete Medical Billing Fundamentals Course can be found here.

We also offer just the course documents and forms from the Fundamentals Course for reduced cost here.

Introduction

  • What is Medical Billing
  • Coding versus Billing
  • Jack of All Trades – Typical Tasks & Responsibilities
  • The Payment Process

Terminology & Acronyms

  • Commonly Used Medical Billing Terms
  • Acronyms
  • Abbreviations

Health Insurance Plans

  • Insurance Types
  • Insurance Payers
  • Medicare & Government Payers
  • Insurance Verification
  • Credentialing
  • Patient Responsibilities

Provider & Patient Setup

  • Before Sending a Claim
  • Practice Management Software
  • CMS-1500 Form
  • Other Important Forms
  • Patient Insurance Information

Introduction to Medical Coding

  • Why We Use Codes
  • Medical Diagnosis Codes
  • Medical Treatment Codes
  • Where Codes are Used

Creating & Submitting Claims

  • Creating Claims
  • Using a Claim Clearinghouse
  • Claim Hurdles
  • Claim Attachments

Fraud, Abuse, & Privacy

  • Health Insurance Portability & Accountability Act (HIPAA)
  • Privacy & Security Standards
  • Protecting Patient Information
  • Working Remotely
  • Fraud & Abuse
  • Examples of Fraud & Abuse
  • Consequences

Resolving Claim Problems

  • Multiple Claim Checks
  • Why Claims are Not Paid
  • Reason Codes & Insurance Adjustments
  • Common Reasons for Claim Denial
  • When Errors are Detected
  • Appealing a Claim

Posting & Applying Payments

  • Posting Insurance Payments
  • ERA’s & EOB’s
  • Patient Statements
  • Patient Collections
  • Aging Reports

Career Options in Medical Billing

  • Medical Billing Certification
  • CMRS Exam
  • AAPC Billing Certification
  • Where the Jobs Are
  • Getting a Job With No Experience
  • Starting a Business From Home

Medical Billing Fundamentals

$97.00

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