Medical Insurance Billing

This six-course program is designed for those who are new to the medical field and for those currently working in the field who wish to expand their knowledge in specific areas. Students will become versed in the terminology of the medical profession, knowledgeable in the areas of billing procedures and coding, credit and collection, legal issues and risk management. When you complete the program, you will be able to effectively deal and help with problem-solving activities in a medical business environment. HPAA Compliance and Regulations are included. Program consists of six courses that must be taken in the following order: 

1. MB1 Medical Terminology
2. MB2 Coding: ICD-9CM/CPT-4/HCPCS
3. MB3 Medical Insurance Billing Principles
4. MB4 Medical Credit and Collection: Recovery of Unsecured Assets
5. MB5 Legal Issues and Risk Management
6. MB6 Computerized Medical Insurance Billing

Participants will earn a Mt. SAC Community Education Certificate of Completion when all six courses have been successfully completed. Attendance and examination requirements must be met before a certificate can be issued.

MB1-Medical Terminology

This course is designed for individuals who want to pursue a career or enhance their potential for advancement in the healthcare field. Examples of key and relevant topics, which will be presented, analyzed, and discussed, are the following: the rules and structure of medical terminology, anatomy and functions of the organ/system being studied, and the etiology, diagnostic procedures and management of pathological conditions. HIPAA Compliance Regulations included.

MB2- ICD-9 Coding

ICD10-CM coding is required by third-party payers when submitting and processing insurance claims.   In this class, students will learn to interpret accurately and describe diagnoses, procedures and supplies used in the physician offices, medical record department, emergency rooms, urgent care and hospice care facilities. In CPT-4 coding, students will learn how to effectively use evaluation and management codes in compliance with CMS regulations, the correct usage of modifiers that Best describes inpatient procedures, and services in compliance with CMS. Students will be informed about the changes and updated code requirements. Hands-on diagnoses and including problem solving of case studies using ICD10-CM will be covered in class.   Cost of textbooks is approximately $ 187.00 (ICD10 & CPT4) plus $20.00 for material fee payable in class.  Prerequisite: Medical Terminology.
 
Upon completion of this course, students will be able to:

• Understand basic to advance coding principles and regulations
• Perform hands-on actual coding of ICD10-CM/ CPT-4 /HCPCS
•  Code accurately, specific and in a timely manner
• Professionally handle patients concerns, co-workers, and physicians in compliance with HIPAA.

  This course falls under the following Institutional Level Outcome (ILO):

• Communication
• Critical Thinking
• Information Technology and Literacy
• Personal, Social, Civic, and Environmental Responsibility

MB3 Medical Insurance Billing Principles Hands-On

*Prerequisite: Medical Insurance Coding
Students will learn the basic principles of medical billing, recognize the different forms used by third-party payers, create a clean claim (1500 form) and define insurance billing terminology and types of coverage. Students will learn the responsibilities of a medical insurance specialist, the life cycle of insurance claim, and various templates of billing commercial insurance. Learning coding ICD-10-CM is important, anticipating the major changes in processing claims effective October 1, 2015 the effective date of ICD-10-CM in the United States. Uses textbooks from previous classes.

MB4 Medical Credit and Collection Recovery of Unsecured Assets

This course will teach you how to work more efficiently in following up on unpaid claims for Medicare, HMO/PPO, and private insurance. Learn to analyze monthly reports, accounts receivable, revenue outstanding and delinquent accounts. Learn to file tracers, CIF's and appeals on denied claims for Medi-Cal.

MB5 Legal Issues and Risk Management

Students will learn the importance of confidentiality of medical records in California; when to release or retain medical records; when to resort to arbitration versus civil courts; how to prevent malpractice claims and the importance of informed consent. HIPAA Compliance Regulations included.

MB6 Computerized Medical Insurance Billing

*Prerequisites: Legal Issues and Risk Management and previous computer experience is necessary.
Participants will learn the basics of how to input patient information and insurance data, generate insurance claim forms, statements, collection letters, edit lists and other required forms in a business office to facilitate productive operations. This hands-on workshop is highly recommended for billing service businesses and good preparation for working in medical facilities. HIPAA Compliance Regulations included.