Medical Billing and Coding (Voucher Included)

Disclaimer

Continuing Education is a program of Santa Fe College's Center for Innovation and Economic Development (CIED).

These courses are non-credit, Industry certification courses and are not eligible for financial aid. Please contact Continuing Education at 352-395-5896 with questions, or for additional information.

Overview

Whether you’re just starting work or transitioning into a different field, there has never been a better time to enter a career in Medical Billing and Coding. This course will prepare you for success in this rewarding career as you learn about legal, ethical, and regulatory concepts central to this field, including HIPAA compliance, official coding guidelines, and third-party payer requirements. You will also be able to choose a voucher for the professional certification that best aligns with your interests and career goals.

More than one million practicing physicians in the United States rely on medical billers and coders to receive payment for their services. Besides medical facilities, positions are available with health insurance companies, specialty pharmacies, medical suppliers, consulting firms, and national medical coding and billing companies, so the opportunities are nearly endless!

Medical billers and coders are in high demand. This course offers valuable training in legal, ethical, and regulatory concepts central to this field, including HIPAA compliance, official coding guidelines, and third-party payer requirements. You will also come to understand all phases of the revenue cycle—from patient registration through medical coding, claims submission, reimbursement, and collections. You will also learn common medical terminology to help you converse with others in healthcare easily and with confidence. You will study word parts and the structures and functions of the human body. Also presented are the disorders and medical procedures common to each body system, including musculoskeletal, cardiovascular, respiratory, digestive, nervous, endocrine, integumentary, genitourinary, lymphatic, and immune.

After successfully completing the course requirements, you should be well prepared to find your place in this rewarding healthcare career. You will receive a Certificate of Completion from the school through which you enrolled, and you will also be able to choose a voucher for the professional certification that best aligns with your interests and career goals.

Certified Professional Coder (CPC) exam offered by the American Academy of Professional Coders (AAPC)
Certified Coding Associate (CCA) exam offered by the American Health Information Management Association (AHIMA)
Certified Billing and Coding Specialist (CBCS) exam offered by the National Healthcareer Association (NHA)

Details

What you will learn

Medical coding terminology is required for medical coding, including the structures and functions of the human body
The disorders and medical procedures common to each body system
Legal, ethical, and regulatory concepts central to the field, including HIPAA compliance and third-party guidelines for filing insurance claims.
The main coding manuals: ICD-10-CM, ICD-10-PCS, CPT, and HCPCS Level II.
How to code diagnoses, services, and procedures for all systems of the body
Fundamentals of medical billing & coding and medical terminology
Word parts and the structures and functions of the human body

How you will benefit

Get hands-on, practical experience in medical billing and coding that will help you on the job.
Receive a certificate of completion and prepare to sit for the professional certification that best aligns with your interest and career goals.
- Certified Professional Coder (CPC) exam offered by the American Academy of Professional Coders (AAPC)
- Certified Coding Associate (CCA) exam offered by the American Health Information Management Association (AHIMA)
- Certified Billing and Coding Specialist (CBCS) exam offered by the National Healthcareer Association (NHA)
Receive a voucher for the professional certification exam of your choice
Receive access to study materials that align with the exam option you choose

Outline

Medical Terminology
1. Introduction to Medical Terminology
2. The Musculoskeletal System
3. The Cardiovascular System
4. The Lymphatic and Immune Systems
5. The Respiratory System
6. The Digestive System
7. The Urinary System
8. The Nervous System
9. The Special Senses The Eyes and Ears
10. The Integumentary System
11. The Endocrine System
12. The Reproductive System
13. Diagnostic Procedures, Nuclear Medicine, Pharmacology
Medical Billing and Coding
1. Introduction to Medical Billing and Coding
  1. Career Opportunities
  2. Personal and Technical Qualifications
  3. Employment Settings
  4. Telecommunications
  5. Professional Certifications
2. Introduction to Health Insurance
  1. Health Insurance Terminology
  2. Commercial and Government Payers
  3. Healthcare Documentation
  4. Electronic Health Record
3. Managed Healthcare
  1. Types of Reimbursement
  2. Managed Care Providers
  3. Managed Care Models
  4. Consumer-Directed Health Plans
4. Revenue Cycle Management
  1. Phases of Revenue Cycle Management
  2. Encounter Form, Chargemaster
  3. Insurance Claim Cycle
  4. New Patient Registration
  5. Collection Practices
5. Legal Aspects of Health Insurance and Reimbursement
  1. Laws Affecting Healthcare
  2. Protected Health Information
  3. Health Insurance Portability and Accountability Act (HIPAA)
  4. Fraud and Abuse in Medical Billing and Coding
  5. Release of Information
6. VI. ICD-10-CM Coding
  1. Overview of ICD-10-CM
  2. Key Features
  3. Organization of the Codebook
  4. Index to Diseases and Injuries
  5. Tabular List of Diseases and Injuries
  6. Coding Conventions
  7. Official Guidelines
7. CPT Coding
  1. Overview of Healthcare Common Procedure Coding System (HCPCS)
  2. Category I, Category II, and Category III Codes
  3. Organization of the Codebook
  4. Main CPT Sections
  5. Evaluation and Management
  6. Anesthesia
  7. Surgery
  8. Radiology
  9. Pathology and Laboratory
  10. Medicine
  11. Code Modifiers
8. HCPCS Level II Coding
  1. Overview of HCPCS Level II
  2. Organization of the Codebook
  3. Durable Medical Equipment
9. ICD-10-PCS Coding
  1. Overview of ICD-10-PCS
  2. Code Structure
  3. Definitions
  4. Index
  5. Code Tables
  6. Coding Steps
10. Pharmacology for Coders
  1. Pharmacodynamics and Pharmacokinetics
  2. Routes of Administration
  3. Drug Classifications
  4. Prescription Drugs and Over-the-Counter Drugs
  5. Controlled Substances
  6. Medication Lists and the Electronic Health Record
  MIDTERM
11. Clinical Documentation Improvement (CDI)
12. 1. Deficiencies in Documentation
  2. Medical Necessity
  3. Auditing
  4. Coding From Patient Documentation
13. Insurance Claims
  1. National Uniform Claim Committee
  2. CMS-1500 Claim Form
  3. Patient and Insured Information
  4. Physician or Supplier Information
  5. UB-04 Claim Form
14. Commercial Insurance
  1. Individual/Group Health Insurance, Automobile, Disability, Liability, Workers’ Compensation
  2. Completing Commercial Health Insurance Claims
15. Blue Cross Blue Shield
  1. History of BCBS
  2. Types of BCBS Plans
  3. Participating/Nonparticipating Providers
  4. BCBS Billing and Payment Guidelines
16. Medicare
  1. Medicare Eligibility
  2. Medicare Part A, B, C, and D
  3. National Coverage Determinations/Local Coverage Determinations
  4. Participating/Nonparticipating Providers
  5. Physician Fee Schedule
  6. Medicare Billing and Payment Guidelines/NCCI
17. Medicaid, CHIP, TRICARE, Workers’ Compensation
  1. Medicaid
  2. Children’s Health Insurance Program (CHIP)
  3. TRICARE
  4. Workers’ Compensation
18. Certification
  1. Selecting the Right Certification
  2. Study Strategies for the Certification Exam
  3. Prior to the Exam
  4. Morning of the Exam
  5. During the Exam
19. How to Find a Job in Medical Billing and Coding
  1. Formulating Your Career Goals
  2. What Employers Want
  3. Showcasing Your Skills
  4. Resume Tips
  5. Cover Letter Tips
  6. Interview Questions
FINAL

Requirements

Hardware Requirements:

This course can be taken on either a PC or Mac device.

Software Requirements:

PC: Windows 8 or later operating systems.
Mac: OS X Snow Leopard 10.6 or later.
Browser: The latest version of Google Chrome or Mozilla Firefox is preferred. Microsoft Edge is also compatible.
Microsoft Word or equivalent (not included with enrollment)
Download the Adobe Acrobat Reader.
Software must be installed and fully operational before the course begins.

Other:

Email capabilities and access to a personal email account.

Instructional Material Requirements:

The instructional materials required for this course are included in enrollment. The following textbook, workbook, and codebooks will be shipped to you approximately 7-10 business days after enrollment:

Understanding Health Insurance: A Guide to Billing and Reimbursement, by Michelle A. Green
Accompanying Workbook: Understanding Health Insurance: A Guide to Billing and Reimbursement
ICD-10-CM Expert for Physicians
CPT Professional
HCPCS Level II Professional

Choice of study guide/voucher package upon course completion:

CBCS Study Guide
Professional Review Guide for the CCA Examination + ICD-10-PCS Expert
Official CPC Certification Study Guide

Prerequisites

There are no prerequisites to take this course. However, in order to sit for national certification exams, candidates must have a high school diploma or equivalent. Therefore, it is recommended you have this before enrolling in this course.

Instructor

Nancy Smith has over 30 years of experience in the healthcare industry. Her clinical experience includes working as a medical assistant for a network of rural health clinics, and as a medical coder, insurance claims specialist, and medical records auditor. She worked as a medical office manager for ten years, where she recruited and trained all medical assistants. Nancy holds a bachelor's degree in vocational education and has developed and taught medical assistant programs.

LaTisha Cottingham has over 20 years of experience in the healthcare industry. She has six years of teaching experience in the field of medical billing and coding and Medical Assisting. Currently she is employed as an HIM Analyst for a Long-Term Care establishment that is based out of Alabama. Previously she was employed as the lead instructor for the Allied Health Department for a local career institute. LaTisha's field of expertise is in the area of physician-based inpatient coding and Emergency Department coding. The certifications that she holds are as follows: a Registered Health Information Technician (RHIT), a Certified Professional Coder (CPC), and a Certified Clinical Medical Assistant (CCMA). In preparation for ICD-10-CM, LaTisha received her ICD-10-CM/PCS Trainer Certification from American Health Information Association (AHIMA), where she is currently a member. LaTisha is also a member of the American Academy of Professional Coders (AAPC) and the National Healthcare Association (NHA) where she is a test proctor.

Carline Dalgleish has worked in medical office administration for over 30 years. She holds a bachelor's degree in Business Information Systems, a master's degree in Leadership, and a post-baccalaureate certificate in Health Information Management. She is a Registered Health Information Administrator and an AHIMA Approved ICD-10-CM/PCS Trainer. Dalgleish is the author of an ICD-10 coding system and owns her own consulting firm, AnnGrant Educational Services.

Lydia S. Stewart, RN, B.S.N., currently serves as the Revenue Cycle Manager at a large regional medical center. Lydia has been a Registered Nurse for 23 years, 15 of those years specializing in Critical Care Nursing and supervision. She is responsible for Medical Audits, Charge Capture, and governmental compliance audits and reviews. Lydia is a member of the Louisiana Medical Auditor Association and Healthcare Financial Management Association (HFMA).

Bunny Reeves is the senior ambulatory surgery coder at the Maimonides Medical Center in Brooklyn, New York. She trains student coders at Maimonides Medical Center and previously trained and supervised entry-level coders at Staten Island's St. Vincent Medical Center. Reeves is a Certified Coding Specialist, accredited by the American Health Information Management Association (AHIMA).

Sharon L. Blackford, MA, B.A., RMA, has over 30 years of experience in the medical field. She has a Master's degree in Organizational Management, a Bachelor's degree in Business Management, and has served as a Registered Medical Assistant since 1994. Sharon was an active duty Clinical Specialist in the U.S. Army for 10 years. Sharon later moved to the Gulf Coast to accept a position as the Director of Education of Blue Cliff College and was promoted to Campus Director.

Stacey O'Brien has more than 10 years of experience in medical coding and reimbursement. Ms. O'Brien has been a risk adjustment coder for a Medicare advantage plan, audited medical records for a consulting firm, and currently supervises the coding and electronic claims submission process for a group medical practice. She has a bachelor's degree from the University of Pittsburgh and a CPC coding certification from the AAPC.

FAQs

What is medical billing and coding?

Medical Billers and Coders are responsible for processing patient data including medical records and related insurance. In this position, you will code a patient's diagnosis and then request payment from the patient's insurance company. You will play an important role in ensuring that healthcare providers are quickly and accurately paid for the treatment they give patients.

Where do you work as a Medical Biller and Coder?

Medical Billers and Coders work in a variety of settings. The most common settings include hospitals, doctors' offices and insurance agencies. Some medical billing and coding professionals work for companies that develop medical software, and some work for education institutions that work to train other medical billers and coders. Government agencies have also been known to employ medial billers and coders including the National Center for Health Statistics and Medicaid offices. You may also have the ability to work for a reputable company from your own home!

What is a day in the life of a Medical Biller and Coder like?

A day in the life of a Medical Biller and Coder is a rewarding one. You are responsible for ensuring that healthcare providers receive appropriate compensation for the care they provide as well as helping patients get the maximum benefit of their insurance. It is a job that requires a high level of attention to detail at all times because codes must be correct to produce appropriate bills for services. Much of your time will be spent in front of a computer organizing statements, reviewing bills, and performing quality control. You also may be required to negotiate with insurance companies via phone on behalf of providers or patients. It's also important to coordinate with other coders to ensure accuracy and adherence to standards. Finally, you'll want to keep up on the latest developments and regulations in the industry through continuing education.

What is the difference between a Medical Biller and a Medical Coder?

Medical billers are mainly responsible for submitting patient records to government agencies and insurance companies for services that have been provided in the care of the patient. Medical coders gather information on patient records and assign the proper codes for patient diagnosis which are then used by medical billers to submit claim forms.

Is medical billing and coding in high demand?

Yes. There is a high demand for qualified medical billing and coding professionals in the healthcare industry today. Demand will increase as the population in the Unites States ages. Jobs for these professionals are on the rise and expected to grow faster than average through 2026 according to the Bureau of Labor Statistics.

What is the salary for a Medical Biller and Coder?

According to the AAPC based on its membership, the average Medical Biller and Coder without certification earns around $45,000 per year while those with certification earn an average of $51,500. This means that certification can help you earn up to 15 percent more in this field! Other salary websites place the median salary for those starting out in Medical Billing and Coding around $38,500.

How long do you have to go to school to become a Medical Coder?

Our medical coding courses are self-paced and completed in 12 months or less. You will then have the option to prepare and sit for one of the following national certifications: 1) NHA's Certified Billing and Coding Specialist (CBCS), 2) AAPC’s Certified Professional Coder (CPC), or 3) AHIMA’s Certified Coding Associate (CCA). Once you are certified, you'll have the qualifications you need to find an entry-level job.

How do I become a Medical Coder without experience?

The path to a career in medical billing and coding typically starts with certification. There are different medical billing and coding certifications offered through certifying bodies, so it's important to choose which one is right for you. This course allows you to choose one of three national certifications to sit for upon completion.

How do I get a medical coding certification online?

To become a Certified Medical Coder, you need to take an online training course that teaches you the CPT®, ICD-10-CM, and HCPCS Level II code sets. Most employers are looking for applicants to have a medical coding certification. After successfully completing this course, you will have the knowledge and skillset to become a medical coder and can sit for one of three national certification exams included in your tuition: 1) NHA's Certified Billing and Coding Specialist (CBCS), 2) AAPC’s Certified Professional Coder (CPC), or 3) AHIMA’s Certified Coding Associate (CCA).

Do Medical Billers or Medical Coders make more money?

Due to the more technical nature of the job and increased training required, medical coders do tend to make more than medical billers on an annual basis. Both medical billers and medical coders are in high demand. Medical billers earn a median salary of nearly $37,000. The salary of medical coder depends on a variety of different factors including certifications, specialties and experience, but the American Academy of Professional Coders (AAPC) reports that their average salary is around $47,800.

Can you get a job as both a Medical Biller and a Medical Coder?

Other than a handful of exceptions, medical billing and medical coding are two separate professions. You do not need a degree for either profession, but successful coders usually obtain certification. This course will fully prepare you for a career as either a medical biller or a medical coder, including recommended certification. Once you've completed your training, you will decide which area fits your personality and career goals best and move in that direction.

What is a CPC?

CPC, or Certified Professional Coder, is the primary medical coding credential offered by AAPC. AAPC's CPC certification is the gold standard in medical coding and represents world-class expertise that is highly sought and well-compensated by medical organizations across the country.

What does CPC mean for my career in medical coding?

The CPC certification is the gold standard in medical coding and represents world-class expertise that is highly sought and well-compensated by medical organizations across the country.

How do I get my CPC certification?

After successfully completing this online course, you will receive a prepaid voucher to register for the CPC Exam and schedule your test date. Registration should be done three weeks prior to the exam date. After passing the CPC exam, you will have your CPC-A designation without 2 years of prior experience. Completion of the included CPC Practicode will qualify as 1 year of experience towards the full CPC designation. Completing this program also qualifies for 1 year of experience, thus completing both steps and passing the CPC exam will provide you with the full CPC designation and remove the Apprenticeship status.

What is the CPC exam?

The Certified Professional Coder (CPC) exam is administered by the American Academy of Professional Coders (AAPC). It is a common advanced credential for medical coders in physician office settings.

How long is a CPC certificate valid for?

Once the CPC designation is achieved, your AAPC Membership (included) is required to be renewed annually and 36 Continuing Education Units (CEU's) must be submitted every two years for verification and authentication of expertise.

How to become a Certified Professional Coder?

Medical billing and coding is hardly a career you can jump into and learn on the job. A medical biller and coder must understand the Healthcare Common procedure Coding System (HCPCS), as well as CPT Category II codes and ICD-10 codes. Training courses will teach you what these codes are, how to use them, and how to assign them in common medical billing and coding procedures

How much does a Certified Professional Coder make?

CPCs make between $18 and $25 per hour, varying by location, experience, and additional credentialing.

What does AAPC stand for?

AAPC, or the American Academy of Professional Coders, is an independent organization founded in 1988 to provide education and professional certification to medical coders. They have over 190,000 members and offers 28 certifications related to medical billing, medical coding, healthcare documentation and more.

What is the CCA exam?

The Certified Coding Associate (CCA) exam is an entry-level certification provided through the American Health Information Management Association (AHIMA). It indicates proficiency in medical coding in hospital and office settings.

What does CBCS stand for?

CBCS stands for Certified Billing and Coding Specialist, and it is a designation earned from the nationally recognized National Healthcareer Association (NHA). With this credential, you'll gain billing and coding skills that are essential to various medical facilities including hospitals, surgery centers, physician offices, nursing homes, mental health facilities, home healthcare agencies, and dental offices. Earning your CBCS credential will prove to prospective employers that you have what it takes to work with patient information, prevent fraud and abuse, support coding and billing practices, submit claims, and help healthcare providers gain maximum reimbursement for services.

Can I register for courses if I am an international student?

Yes, ed2go courses are completely online. However, keep in mind that not all certifying bodies or industry-specific certifications are recognized internationally. Please review your country’s regulations prior to enrolling in courses that prepare for certification.

Does this course prepare for a certification?

Yes, this course prepares you for three certifications: 1) Certified Billing and Coding Specialist (CBCS) exam, offered by the National Healthcareer Association (NHA), 2) Certified Professional Coder (CPC) exam, offered by American Academy of Professional Coders (AAPC), and Certified Coding Associate (CCA) exam, offered by AHIMA. You will receive a voucher for the certification exam of your choosing after successfully completing the course.

When can I start this course?

This course is open enrollment, so you can register and start the course whenever you are ready. Access to your course can take 24-48 business hours.

How long does it take to complete this course?

After you register, you will receive 12 months to complete the course. The time allotted for completion has been calculated based on the number of course hours.

What if I don't have enough time to complete the course within the time frame provided?

If you are unable to complete the course, contact your Student Advisor to help you work out a suitable completion date. Please note that an extension fee will be charged. If you are funded through a third-party organization, approval may also be required.

What kind of support will I receive?

The course instructor will be available by email to answer any questions you may have and to provide feedback on your performance. Occasionally, your course may be supported by a team of industry experts. You will also be assigned a Student Advisor for academic support.

What happens when I complete the course?

Upon successfully passing the final exam, you will be awarded a certificate of completion from the school or organization that you registered through. In addition, you will receive an exam voucher and applicable study materials for your choice of the following national certification exams: 1) NHA's Certified Billing and Coding Specialist (CBCS), 2) AAPC’s Certified Professional Coder (CPC), or 3) AHIMA’s Certified Coding Associate (CCA).

Am I guaranteed a job?

ed2go courses will help you gain the skills you need to obtain an entry-level position in most cases. However, you should always research the job market in your area before enrolling.

Can I get financial assistance?

ed2go courses are non-credit, so they do not qualify for federal aid, FAFSA, and Pell Grant. In some states, vocational rehab or workforce development boards may provide funding to take our courses. Additionally, you may qualify for financial assistance if you meet certain requirements. To learn more about financial assistance.

How can I get more information about this course?

If you have questions that are not answered on our website, representatives are available via LIVE chat. You can also call us at 1-877-221-5151 during regular business hours to have your questions promptly answered. If you are visiting us during non-business hours, please send us a question using the "Contact Us."

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