Curriculum
The Thomas Edison State College Online Medical Billing and Coding Specialist Certificate Program consists of 3 courses - Medical Coding, Medical Billing and Medical Terminology – with a total of 25 modules. Together, these three courses prepare students to work in the exciting field of medical coding and billing. Numerous exercises and skill assessments throughout each module ensure that students master each skill before moving on to the next concept, with knowledgeable student support specialists available to help from program start to finish. Students can expect to spend approximately 680 hours to master this material.
Medical Coding
Module 1: Medical Terminology
- Pronunciation
- Spelling
- Word Roots
- Combining Vowels/Form
- Prefixes
- Suffixes
- General Rules
- Word Building
- Abbreviations
- Procedural and Diagnostic Billing Codes
- Body Structure
- Organization of the Body
- Anatomical Position
- Body Planes
- Directional and Positional Terms
Module 2: Introduction to Coding
- A Career as a Medical Coder
- Types of Coding
- ICD-9-CM
- V Codes and E Codes
- M Codes
- Categories, Subcategories, and Subclassifications
- Procedural Coding with ICD-9-CM
- Procedures in ICD-10-CM
- HCPCS Level II
- HCPCS II Hierarchy
- HCPCS II Medication Flow Chart
- Current Procedural Terminology (CPT)
- AMA/CPT Code Book
- Symbols & Unlisted Codes
- CPT Surgical Guidelines
- Radiology and Pathology Guidelines
- Category II and III Codes
Module 3: Coding for Anesthesia, General Surgery and the Integumentary System
- AMA/CPT Evaluation and Management (E / M) Guidelines
- Criteria of Documentation
- E / M Selection
- Types of Anesthesia
- Anesthesia Coding
- General Surgery
- The Respiratory System
- The Cardiovascular System
- The Hemic and Lymphatic Systems
- The Digestive System
- The Urinary System
- The Nervous System
- The Ocular Adnexa and Auditory Systems
- E / M for Integumentary / Skin
- Surgical Guidelines for Integumentary
- Incision and Drainage
- Debridement
- Biopsy & Removal of Skin Tags
- Intralesional Injections and Tissue Expanders
- Graft Concepts and Tissue Transfer
- Repair and / or Reconstruction
Module 4: Coding for Orthopedics, Cardiology, and OB/GYN
- Fractures
- Dislocations
- Arthropathy
- Vertebral Disorders
- Sprains and Strains
- Cardiac and Vascular Anatomy & Physiology
- 90000 Series of CPT
- Intracardiac Electrophysiological Procedures
- Other Vascular Studies
- Noninvasive Vascular diagnostic Studies
- 30000 Series of CPT
- Radiology
- Using Modifiers Effectively
- Category II Codes
- Unique Aspects of Coding OB/GYN
- The Female Reproductive System
- Obstetrics and Gynecology (OB/GYN)
Module 5: Coding for Radiology, Pathology, Laboratory & General Medicine
- Radiology & CPT Coding
- Diagnostic Radiology & Ultrasound
- Radiation Oncology & Nuclear Medicine
- CPT – Pathology and Laboratory
- Evocative/Suppression Testing
- Hematology and Coagulation
- Transfusion Medicine
- Anatomic Pathology
- Surgical Pathology
- General Medicine Guidelines
- Immunization Administration
- Therapeutic Infusions & Injections
- Psychiatry & Psychiatric Therapeutic Care
- Dialysis
- Gastroenterology
- Ophthalmology
- Otorhinolaryngology Services
- Cardiology & Pulmonary
- Endocrinology
- Neurology and Neuromuscular Procedures
- Photodynamic Therapy & Dermatological Procedures
Module 6: Billing, Collections, Filing the Claim Form, Payment, & Inpatient Coding
- Patient Registration
- Ambulatory Patient Groups
- Payment and Billing Processes
- The Collections Process
- Professional Courtesy
- The Health Insurance Claim Form
- Medicaid & Medicare
- Submitting a Claim for a Deceased Patient
- Health Maintenance Organizations (HMOS)
- CHAMPUS / TRICARE / CHAMPVA
- Workers’ Compensation
- Encounter Forms, Superbills, Fee Slips, or Charge Tickets
- Step-By-Step Completion of a Paper CMS 1500 From
- Appealing the Claim
- Insurance Participation Agreements
- Denials, Rejections & Appeals
- Auditing & Fraud Risk Prevention
- Hospital Based ICD-9-CM Coding
- Unconfirmed Conditions
- Code Assignment
- Hospital Reimbursement Environment
Module 7: CCA Test Preparation – Part 1
- Examination Study Strategies and Resources
- Coding Review
- Health Data Content, Requirements, and Standards
- Medical Science
- Classification Systems and Secondary Data Sources
Module 8: CCA Test Preparation – Part 2
- ICD-9-CM Coding
- CPT Coding
- Medical Billing and Reimbursement Systems
- CCA Quiz
- CCA Mock Examination
Medical Billing
Module 1: Medical Terminology
- Pronunciation
- Spelling
- Word Roots
- Combining Vowels/Form
- Prefixes
- Suffixes
- General Rules
- Word Building
- Abbreviations
- Procedural and Diagnostic Billing Codes
- Body Structure
- Organization of the Body
- Anatomical Position
- Body Planes
- Directional and Positional Terms
- Body Cavities
Module 2: Foundations of Health Insurance
- Health Insurance Specialist Career
- Job Responsibilities
- Professionalism
- Introduction to Health Insurance
- Medical Documentation
- Electronic Health Record (EHR)
- Managed Health Care
- Managed Care Organizations
- Effects of Managed Care
- Processing of an Insurance Claim
- Managing New Patients
- Insurance Claim Life Cycle
- Credit and Collections
- Legal and Regulatory Issues
- Health Insurance Portability and Accountability Act (HIPAA)
Module 3: Understanding Coding
- ICD-9-CM Coding
- Medical Necessity
- Outpatient Coding Guidelines
- Learning the ICD-9-CM Coding System
- CPT Coding
- CPT Sections, Subsections, Categories and Subcategories
- Coding Procedures and Services
- National Correct Coding Initiative
- HCPCS Level II Coding
- HCPCS Level II National Codes
- Determining Payer Responsibility
Module 4: Reimbursement Methodologies
- CMS Reimbursement Methodologies
- CMS Payment System
- Ambulance Fee Schedule
- Ambulatory Surgical Center Rates
- Clinical Laboratory Fee Schedule
- Home Health Prospective Payment System
- Hospital Payment System
- Inpatient Psychiatric & Rehabilitation Payment System
- Skilled Nursing Facility Payment System
- Revenue Cycle Management
- Coding for Medical Necessity
- Applying Coding Guidelines
- Coding and Billing Considerations
- Coding from Case Scenarios
Module 5: Understanding Insurance
- Essential CMS-1500 Claim Instructions
- Insurance Billing Guidelines
- Optical Scanning Guidelines
- Entering Patient and Policyholder Names
- Recovery of Funds from Responsible Payers
- National Provider Identifier (NPI)
- Reporting Diagnoses: ICD-9-CM Codes
- Reporting Procedures and Services: HCPCS/CPT Codes
- Steps in Processing Claims
- Commercial Insurance
- Automobile, Disability and Liability Insurance
- Commercial Group Health Plan Coverage
- Blue Cross Blue Shield (BCBS) Plans
- Billing Notes & Claims Instructions
- BCBS Secondary Coverage
Module 6: Medicare & Medicaid
- Medicare Eligibility & Enrollment
- Medicare Parts A, B, C, & D
- Employer and Union Health Plans
- Medigap
- Mandatory Claims Submission
- Advance Beneficiary Notice
- Medicare Summary Notice
- Medicare-Medicaid (Medi-Medi) Crossover Claims
- Roster Billing for Mass Vaccination Programs
- Medicaid Eligibility
- Medicaid Covered Services
- Payment for Medicaid Services
- Mother/Baby Claims
- SCHIP Claims
Module 7: TRICARE & Workers’ Compensation
- TRICARE Background & Administration
- CHAMPVA
- TRICARE Options
- TRICARE Programs
- TRICARE Supplemental Plans
- Billing Notes & Claims Instructions
- Federal Workers' Compensation Programs
- State Workers' Compensation Programs
- Eligibility for Workers' Compensation Coverage
- Workers' Compensation and Managed Care
- First Report of Injury Form
- Progress Reports
- Appeals and Adjudication
- Fraud and Abuse
Medical Terminology
Module 1 : Medical and Anatomical Terminology
- Word Root/Combining Forms
- Prefixes & Suffixes
- Word Examples Using Word Parts
- Information Frame
- Spell Check Tips
- Review Exercises
Module 2: Blood Cells, Cardiovascular and Lymphatic Systems
- Word Root/Combining Forms
- Prefixes & Suffixes
- Word Examples Using Word Parts
- Information Frame
- Spell Check Tips
- Review Exercises
Module 3: Nervous System and Tumors
- Word Root/Combining Forms
- Prefixes & Suffixes
- Word Examples Using Word Parts
- Information Frame
- Spell Check Tips
- Review Exercises
Module 4 : Digestive System
- Word Root/Combining Forms
- Prefixes & Suffixes
- Word Examples Using Word Parts
- Information Frame
- Spell Check Tips
- Review Exercises
Module 5 : Muscles, Bones and Joints
- Word Root/Combining Forms
- Prefixes & Suffixes
- Word Examples Using Word Parts
- Information Frame
- Spell Check Tips
- Review Exercises
Module 6: Male Reproductive and Urinary Systems
- Word Root/Combining Forms
- Prefixes & Suffixes
- Word Examples Using Word Parts
- Information Frame
- Spell Check Tips
- Review Exercises
Module 7: Female Reproductive System, Obstetrics and Neonatology
- Word Root/Combining Forms
- Prefixes & Suffixes
- Word Examples Using Word Parts
- Information Frame
- Spell Check Tips
- Review Exercises
Module 8: Eye, Ear, Respiratory System and Special Senses
- Word Root/Combining Forms
- Prefixes & Suffixes
- Word Examples Using Word Parts
- Information Frame
- Spell Check Tips
- Review Exercises
Module 9: Directions and Regions of the Body
- Word Root/Combining Forms
- Prefixes & Suffixes
- Word Examples Using Word Parts
- Information Frame
- Spell Check Tips
- Review Exercises
Module 10: Pathogenic Organisms, Endocrine System and Medical Specialties
- Word Root/Combining Forms
- Prefixes & Suffixes
- Word Examples Using Word Parts
- Information Frame
- Spell Check Tips
- Review Exercises