Medical Claims and Billing Training
Details
This medical claims and billing training course highlights the key concepts and guidelines that underpin the billing process. This Course introduces you to the fundamentals of health insurance and reimbursement. You’ll learn principles of medical billing, as they relate to proper claim form preparation, submission and payment processing, and follow-up processes.
Outline
Health Insurance Models and Consumer Driven Health Plans
- Group vs individual health plans
- Health Maintenance Organizations (HMO)
- Managed Care Organizations (MCO)
- Accountable Care Organizations (ACO)
- Government payers
- Physician credentialing/NPI requirements
Patient Registration Process and Data Capture
- Overview of an office visit
- Patient types
- Demographic and insurance information
- Medical insurance coverage validation
- Authorization form
- Encounter form
- Discharge process/check-out
Current Procedural Terminology (CPT) Concepts
- Evaluation and management codes
- Anesthesia
- Surgery
- Radiology
- Laboratory
- Medicine
- Modifiers
HCPCS Level II Concepts
- HCPCS Level II codes
- HCPCS Level II modifiers
- Reporting for discarded drugs/medications
Billing
- Fee schedules
- Data entry
- Claim Forms
- Reduce payment delay
- Prior authorization
- Claim scrubbers
- A/R deposit balancing
- Technology and insurance claims submission
- Audits
- Hospital facility billing
- Primary vs secondary insurance
Accounts receivable (A/R) and Collection Concepts
- Explanation of Benefits (EOB) and Remittance Advice (RA)
- A/R management
- Denials and appeals
- Patient statements
- Refunds
- Professional courtesy, discounts, and financial hardship
- Patient collection practices
- Bankruptcy concepts
Special Offer
Register 5 participants on the same course on the same dates at the cost of 4 participants.
Applicable to all open courses
Schedules
Tue, Wed, Thu, Fri |
No. of Days: | 4 |
The purpose of Human Enterprise Resources and Outsources (Hero) Advisory & Consulting is to help all types of organisations achieve peak performance by promoting proven governance positive behaviours and reducing negativity and poor performance.
Our approach is to address the context for behaviour and to help individuals and the organisation establish and sustain a culture of trust and commitment. This has been repeatedly shown as the most effective and sustainable way of improving motivation, performance and productivity.
Hero is leader in collaborative organization design and governance transformation. With the most integrated and comprehensive methodology, the team at Hero enable clients to realize their future ambitions.