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 Billing Module 1
Career Role & Responsibilities

  • Insurance Billing Specialist
  • Insurance Claims, Coding, & Billing Background
  • Medical Etiquette
  • Medical Ethics
  • Health Insurance Portability and Accountability Act (HIP AA)
  • Using Electronic Technologies
  • SNOMED
  • The Privacy Rule
  • Basics of Health Insurance
  • Legal Principles of Insurance
  • The Insurance Policy
  • Choice of Health Insurance

Medical Billing Module 2
The Claims Process

  • The Documentation Process
  • Documentation Guidelines
  • Contents of a Medical Report
  • Review & Audit of Health Records
  • The Diagnostic Coding System
  • International Classification of Diseases
  • Rules for Coding
  • ICD-9-CM Versus ICD-10-CM
  • Procedural Coding Skills
  • Methods of Payment
  • The CPT Code Book
  • Code Modifiers

Medical Billing Module 3
Paper Claims and Electronic Data

  • Types of Submitted Claims
  • Health Insurance Claim Forms
  • CMS-1500
  • Why Claims are Delayed or Rejected
  • Optical Scanning Format Guidelines
  • Electronic Data Interchange
  • Electronic Claims
  • Transaction & Code Set Regulations
  • Claims Attachment Standards
  • Building the Claim
  • HIPP A & Electronic Claims
  • Records Management

Medical Billing Module 4
Fee & Insurance Collection

  • Follow-Up After Claim Submission
  • Claim Policy Provisions
  • Explanation of Benefits
  • Claim Management Techniques
  • Review and Appeal Process
  • State Insurance Commissioner
  • Cash Flow Cycle
  • Accounts Receivable
  • Fee Schedule
  • Credit Arrangements
  • Credit & Collection Laws
  • The Collection Process

Medical Billing Module 5
Health Care Payers, Part 1

  • Private Insurance
  • Managed Care Systems
  • Medical Review
  • Plan Administration
  • Understanding Medicare
  • Medicare Policies & Regulations
  • Medicare Managed Care Plans
  • Medicare Reimbursement
  • Medicaid Programs
  • Medicaid Eligibility
  • Medicaid Benefits
  • Medicaid Claim Procedures

Medical Billing Module 6
Health Care Payers, Part 2

  • TRICARE Programs
  • TRICARE Standards
  • CHAMPY A Programs
  • TRICARE & CHAMPY A Claims Procedures
  • Workers' Compensation Laws
  • Workers' Compensation Eligibility & Coverage
  • Workers' Compensation Fraud & Abuse
  • Occupational Safety & Health Administration Act (OSHA)
  • Disability Income Insurance
  • Disability Benefit Programs
  • Disability Claims
  • Federal & State Disability Programs

Medical Billing Module 7
Inpatient & Outpatient Billing

  • Hospital Billing
  • Patient Service representative
  • Admissions Procedures
  • Utilization Review
  • Coding Hospital Diagnoses & Procedures
  • Coding Inpatient Procedures
  • Coding Outpatient Procedures
  • Reimbursement Process
  • Billing Problems
  • Hospital Billing Claim Form
  • Employment Opportunities
  • Searching for a Job
  • Self-Employment

Medical Coding Module 1
Overview ofICD-10-CM

  • Reimbursement
  • HIPP A Compliance
  • System Developments & Improvements
  • Outpatient Coding
  • Reporting Guidelines
  • First-Listed Diagnosis
  • Uncertain/Unconfirmed Diagnosis
  • Z-Codes
  • Using ICD-10-CM
  • Organization of Guidelines
  • Accurate Coding
  • Combination Codes

Medical Coding Module 2
ICD-10-CM Chapter-Specific Guidelines

  • Certain Infections
  • Parasitic Diseases
  • Neoplasms
  • Mental & Behavioral Disorders
  • Nervous System Diseases
  • Eye and Ear Diseases
  • Circulatory and Respiratory Systems Diseases
  • Digestive System Diseases
  • Skin Diseases
  • Pregnancy and Childbirth
  • Congenital Malformations
  • Injury and Poisoning

Medical Coding Module 3
Overview of ICD-9-CM

  • ICD-9-CM Format
  • Outpatient Coding
  • Reporting Guidelines
  • Diagnoses
  • VCodes
  • Uncertain Diagnosis
  • Chronic Diseases
  • Therapeutic Services
  • Surgery
  • Organization of the Guidelines
  • Level of Specificity
  • Combination Codes

Medical Coding Module 4
ICD-9-CM Chapter-Specific Guidelines

  • Infections
  • Parasitic Diseases
  • Endocrine and Immunity Disorders
  • Blood Diseases
  • Mental and Behavioral Disorders
  • Circulatory and Respiratory System Diseases
  • Digestive Diseases
  • Diseases of the Genitourinary System
  • Pregnancy and Childbirth
  • Skin Diseases
  • Musculoskeletal Diseases
  • Symptoms, Signs, and Ill-Defined Conditions

Medical Coding Module 5
CPT and HCPCS

  • Intro to CPT
  • Intro to Level II National Codes (HCPCS)
  • Purpose of the CPT Manual
  • CPT Manual Format
  • Starting with the Index
  • History of National Level Codes
  • CPT Modifiers

Medical Coding Module 6
Evaluation and Management, Anesthesia, Surgery

  • Evaluation and Management (E/M) Services
  • Contents of the E/M Section
  • Three Factors of E/M Codes
  • Levels of E/M Service
  • Using E/M Codes
  • Anesthesia
  • Formula for Anesthesia Payment
  • Concurrent Modifiers
  • Unlisted Anesthesia
  • Surgery Guidelines
  • Unlisted Procedures
  • Surgical Package

Medical Coding Module 7
Musculoskeletal, Respiratory, and Cardiovascular Systems

  • Integumentary System
  • Skin and Accessory Structures
  • Nails
  • Burns
  • Musculoskeletal Systems
  • Fractures and Dislocations
  • Casts and Strappings
  • Respiratory Systems
  • Endoscopy
  • Trachea/Bronchi
  • Cardiovascular System
  • Cardiovascular Surgery

Medical Coding Module 8
Digestive, Urinary, and Reproductive Systems

  • Hemic and Lymphatic Systems
  • Diaphragm
  • Digestive System
  • Lips, Tongue, and Mouth
  • Esophagus and Stomach
  • Intestines, Rectum, Liver
  • Pancreas
  • Urinary System
  • Genital Systems
  • Reproductive Surgery
  • Intersex Surgery
  • Maternity Care and Delivery

Medical Coding Module 9
Nervous System and Radiology

  • Endocrine System
  • Nervous System
  • Eye and Ocular Adnexa
  • Auditory System
  • Operating Microscope
  • Radiology
  • Terms and Planes
  • Diagnostic Radiology
  • Breast, Mammography
  • Diagnostic Ultrasound
  • Radiation Oncology
  • Nuclear Medicine

Medical Coding Module 10
Pathology, Medicine, and Inpatient Coding

  • Pathology/Laboratory
  • Therapeutic Drug Assays
  • Evocative/Suppression Testing
  • Clinical Pathology
  • Medicine
  • Dialysis
  • Allergy and Clinical Immunology
  • Neurology
  • Chemotherapy Administration
  • Medical Nutrition Therapy
  • Inpatient Coding
  • Development of the ICD-10-PCS

Medical Terminology Module 1
Basic Word Structure

  • Word Analysis
  • Combining Forms
  • Suffixes & Prefixes
  • Pronunciation of Terms
  • Exercises & Applications

Medical Terminology Module 2
Organization of the Body

  • Body Systems
  • Body Cavities
  • Divisions of the Back
  • Planes of the Body
  • Pronunciation of Terms
  • Exercises & Applications

Medical Terminology Module 3
Suffixes

  • Introduction to Suffixes
  • Suffixes and Terminology
  • Diagnostic & Procedural Suffixes
  • Pronunciation of Terms
  • Exercises & Applications

Medical Terminology Module 4
Prefixes

  • Combining Forms & Prefixes
  • Prefixes and Terminology
  • Define Common Prefixes
  • Pronunciation of Terms
  • Exercises & Applications

Medical Terminology Module 5
Medical Specialists & Case Reports

  • Medical Specialists
  • Combining Forms & Vocabulary
  • Case Reports & Terminology
  • Pronunciation of Terms
  • Exercises & Applications

Medical Terminology Module 6
Body Systems - Part 1

  • Cardiovascular System
  • Digestive System
  • Endocrine System
  • Reproductive System
  • Lymphatic System

Medical Terminology Module 7
Body Systems - Part 2

  • Musculoskeletal System
  • Nervous System
  • Respiratory System
  • Skin & Sense Organs
  • Urinary System

All necessary materials are included.

Certifications:

Upon successful completion of our Medical Billing & Coding Specialist course, students will be prepared for an entry-level position doing medical billing in a medical office setting and will be prepared to sit for the NHA national certification exam to become a Certified Billing and Coding Specialist (CBCS).