Medical Billing Deep Dive: Systems, Regulations, Reimbursement Models, Insurance, Claims, and Coding Basics for Success.
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What you’ll learn
- Understand the complete medical billing process and its role in the U.S. healthcare system.
- Identify key participants in billing, including medical billers, coders, providers, and payers.
- Explain how different types of insurance (Medicare, Medicaid, commercial) affect billing procedures.
- Describe various healthcare providers and facilities, and how billing varies among them.
- Comprehend core billing concepts like deductibles, copayments, coinsurance, and out-of-pocket limits.
- Navigate the medical billing cycle from patient registration to final payment posting.
- Recognize and define key billing terms such as claims, EOBs, superbills, and clearinghouses.
- Understand the purpose and structure of coding systems including ICD, CPT, and HCPCS.
- Learn how proper documentation supports accurate billing and compliance.
- Differentiate between paper and electronic claims, and understand standard forms like CMS-1500 and UB-04.
- Identify common reasons claims are rejected and how to prevent them.
- Explore healthcare reimbursement models including fee-for-service, capitation, and bundled payments.
- Identify types of billing fraud and abuse, and understand the consequences.
- Learn key HIPAA regulations and patient privacy standards in the billing process.
- Learn best practices for ensuring accurate, timely, and compliant billing.
- Explore career paths in medical billing, required skills, and job market expectations.
Course Content
- Introduction to Medical Billing –> 2 lectures • 6min.
- Understanding the Healthcare System –> 3 lectures • 14min.
- Core Concepts in Medical Billing –> 4 lectures • 19min.
- Insurance and Claims Processing –> 3 lectures • 11min.
- Reimbursement and Payment Processes –> 3 lectures • 11min.
- Compliance and Regulatory Requirements –> 3 lectures • 10min.
- Specialized Billing Topics –> 3 lectures • 11min.
- Industry Standards and Best Practices –> 2 lectures • 7min.
- Careers and Future Trends –> 1 lecture • 3min.
Requirements
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This comprehensive course is designed to provide you with a solid foundation in medical billing, whether you are new to the field or looking to enhance your existing knowledge. You will gain a clear understanding of how the medical billing process works within the U.S. healthcare system, including the roles of patients, providers, and payers. From the initial patient visit to final reimbursement, the course walks you through each stage of the billing cycle, highlighting the procedures, terminology, and documentation involved.
You’ll explore how different healthcare facilities operate, how public and private insurance plans like Medicare and Medicaid impact billing practices, and what responsibilities patients carry in terms of copayments, deductibles, and coinsurance. The course also introduces essential coding systems—ICD, CPT, and HCPCS—and demonstrates how accurate coding and proper documentation are crucial to successful claim submission.
As you progress, you’ll learn the differences between paper and electronic claims, how clearinghouses process submissions, and the common reasons for claim rejections. Reimbursement methods are covered in detail, including fee-for-service, capitation, and bundled payments. You will also become familiar with payment documents like Explanation of Benefits (EOB) and Remittance Advice (RA), and understand how to handle claim denials and initiate appeals.
Important compliance topics are also addressed, including HIPAA regulations, patient privacy requirements, and common billing fraud scenarios. You’ll learn about the significance of internal compliance programs in protecting both healthcare providers and patients.
Special topics such as billing for Medicare, Medicaid, workers’ compensation, and out-of-network services are included to prepare you for more complex real-world situations. You’ll also gain insight into the features and functions of medical billing software and learn best practices to ensure accurate, timely claim management.
The course concludes with a look at careers in medical billing, including potential job titles, required qualifications, typical work environments, and salary expectations.
Whether you are aiming for an entry-level position, preparing for certification, or exploring a new career in healthcare administration, this course provides the complete training needed to get started confidently in the medical billing profession.
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