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Medical billing is the process of entering, submitting claims and then following up on claims with health insurance companies in order to receive payment for services rendered by a healthcare provider. The same process is used for most insurance companies, whether they are private companies or government sponsored programs.

For Several decades, medical billing was done almost entirely on paper but with the introduction of Medical practice management software, it has become possible to efficiently manage large amounts of claims electronically.

    Course Objectives:
  • Review an introduction to healthcare from a medical billing perspective.
  • List a variety of health insurance models and how they affect medical entities.
  • Understand the legal regulatory considerations involved in health care reimbursement and collections.
  • Explain the process of a physician-based insurance claim including obtaining patient data, claim form completion, insurance carrier processing and payment received.
  • Demonstrate the ability to use the three major coding manuals, CPT®, ICD-9-CM, and HCPCS, and apply medical necessity standards.
  • Explain the follow up process for A/R in a physician’s office, including the top denials by insurance carrier along with their appeals process.
    Medical Billing Training COURSE CONTENT:
  • Introduction to Healthcare.
  • Health Insurance Models.
  • Patient Registration Process/Data Capture.
  • Introduction to ICD-9-CM Coding.
  • Introduction to CPT® Coding.
  • Introduction to HCPCS Coding.
  • Medical Necessity.
  • Claim Forms (CMS-1500 and UB-04)
  • Billing.
  • A/R and Collection Concepts.
  • Government Carriers (Medicare, Medicaid, and TRICARE).
  • Blue Cross/Blue Shield.
  • Commercial Insurance Carriers.
  • Workers’ Compensation.
Exams Certified Professional Biller (CPB)
The business of healthcare requires certified medical billers with skills to handle all aspects of the revenue cycle. Without expertise in medical billing and the nuances of payer requirements, reimbursement may be compromised. The Certified Professional Biller (CPB™) has proven by rigorous examination and experience that he or she knows how to submit claims in accordance with government regulations and private payer policies, follow-up on claim statuses, resolve claim denials, submit appeals, post payments and adjustments, and manage collections. CPB™ medical billing certification is vital to the financial success of the professional services claims process
    What you will possess after Medical Billing Training Courses:
  • Understanding different types of insurance plans
  • Applying payer policy, Local Coverage Determinations (LCD), and National Coverage Determinations (NCD) for successful claim submission
  • Knowing CPT®, ICD-9-CM, and HCPCS Level II coding guidelines
  • Navigating the varying rules and regulations which apply to the healthcare industry, including HIPAA, False Claims Act, Fair Debt Collections Act, and Stark
  • Knowing the life cycle of a medical billing claim and how to improve the revenue cycle
  • Expertise in effective claim follow-up, patient follow-up, and denial resolution
    Exam Break Down The CPB™ Exam
  • 200 multiple choice questions (proctored)
  • 5 hours and 40 minutes to finish the exam
  • 1 free retake to be used within one year of first of attempt
  • $325 ($260 AAPC Students)
  • Open code book (manuals)
    The exam covers:
  • Types of Insurances
  • Billing regulations
  • HIPAA & Compliance
  • Reimbursement & Collections
  • Billing
  • Coding
  • Case Analysis