Month: May 2018

The Medical Claims Process – Courses in Medical Billing and Coding

Medical Billing Certification Online won’t be complete without a student familiarizing themselves with the medical billing insurance claims process. It is a complicated but entirely necessary procedure that begins after a healthcare provider sends a bill for the medical services they have provided to a patient to the designated payer. In most cases, the latter is a health insurance company who will be analyzing the

claim to see if it merits reimbursement.

As you take your classes Online, you will learn about processing such claims. As an expert in Medical Billing Certification, you will have to insure that before the claim is sent out, all the protocols have been followed. Additionally, there are industry standards that must also be adhered to. Only through constant vigilance will the payment be swift.

At a Medical Technical Institute, you will also be taught how to enter patient data into software and retrieve it when needed in order to prepare claims. The problem with such software is that most healthcare facilities use a different one. Therefore, there is no universal software application that you can learn and apply everywhere. Even so, the good news is that most software like that operates along the same lines. After all, the healthcare providers have to follow the standards set by Code Set Rule (TCS) and HIPAA Transactions.

While studying to receive your Billing Coding Certification Online, you will discover that the insurance claims can be delivered to the payers through two different methods. One is the standard manual method whereby the claim is on paper. The other is the electronic method, which has become the method of preference for most insurance companies and healthcare providers.

That’s because it is cheaper to process an electronic claim – the healthcare providers save $3 per claim. Moreover, electronic claims are generated in less time and lack human error to a high degree. So why should you learn how to do it manually, you ask? Since not all healthcare facilities have switched to the electronic way yet, Medical Billing and Coding Curriculum includes both.

Electronic Method

Billing Coding Certification requires students to be familiar with the electronic method of processing claims. This means that the billing specialist will use software to enter the relevant information into the institutional and non-institutional documents for claims. When this process is done manually, illegible writing, and human error could result in unreadable information. That is not the case here because a scrubbing option removes any errors that it finds in the documents. However, as a medical billing professional, you would need to remain diligent because the software can make mistakes as well.

As you decide Where to Get Medical Billing and Coding, try looking for a course that also teaches students about OCR equipment. The OCR technology is used to scan a document, so that it can separate the information needed and then fill in the relevant fields on a claims form. This makes the processing much faster and efficient. However, the OCR could make an error in reading the code for a procedure performed on the patient. A medical billing specialist must be vigilant enough to catch even a mistaken digit in a medical code and then correct it by hand.

On the flip side, you should also choose a course that teaches you more than just how to use the OCR technology when thinking of Where Can I Learn Medical Billing and Coding. That’s because you will have to convert the documents manually when the OCR equipment is not available. It will involve the use of a tool called crosswalks.

Manual Method

If you are doing the processing manually, then you would need to print out the forms and fill them first. One that is done, paper claims need to be physically mailed to the payers. Vigilance is the only way you can ensure that there is minimal room for error while you do everything manually. For instance, illegible writing or missing digits can mess up medical codes. Similarly, improperly printed documents or missing pages might take place. All such mistakes can result in payment delays.

Medical Billing and Coding Schools also include information about the two most important forms when it comes to processing claims i.e. the CMS-1500 and the UB-04 form. You will learn which form is the right one to use, depending on the conditions. Let us take a brief look at each of them:

CMS-1500

It is maintained by the National Uniform Claim Committee (NUCC). Medical Billing Training will tell you that the CMS-1500 form is universally used by non-institutional healthcare providers. That means it family healthcare physicians and other private practices make use of this form when they need to bill Medicare. If the claim is verified, the healthcare provider will be reimbursed for any services covered under Part B, as well as, certain Medicaid-covered services. Not all tax payers need to fill all the fields given on this form.

UB-04

Form UB-04 is also NUCC-maintained. However, it is used by hospitals and other institutional healthcare providers. This form is filed by a healthcare facility in response to services that are exceptions to the ones charged electronically. The Administrative Simplification Compliance Act (ASCA) mandates that physicians and other health care providers self-assess. If the services they rendered will be considered permitted exceptions, they can thus be filed through the use of manual claims. Not all tax payers need to fill all the fields given on this form.

The insurance claims process is complicated but it is also completely necessary. If you pick out the right institution to teach you the tools you will need to complete such claims on a daily basis, you will do well. That means as a medical billing professional, you need to know how to manually and electronically file a claim. You should be familiar with the industry standards and any regulations unique to the insurance company you are claiming against. Lastly, do much research on clearinghouse and adjudication processes because you will need to know them both!

Medical Billing Terminology – Courses in Medical Billing and Coding

Your Medical Billing Certification Online course will help you familiarize yourself with the terminologies that you will find yourself using on the job every day. As a medical billing specialist, you must know what these words refer to or it might interfere with how well you can do your job.

Besides the billing terms that you will be bandying about, words from other fields will also be a part of your vernacular. For instance, the names of medical procedures, surgical procedures, diseases will also be known to you along with the terms in accounting. Moreover, you will also be expected to have extensive knowledge of the healthcare system and the field of insurance. Lastly, your employer will also expect you to know your way around medical code sets.

Nobody can remember everything. What you can do is take a course on medical billing terminologies that will introduce you to these terms and help you understand them. The better you are at recognizing what a certain term means, the faster you will be at your job. Otherwise, you will just be dragging along a dictionary with you all day long at work!
We have gathered here just some of the terms that you will be taught in the medical billing terminology course. Additionally, we have included their definitions for better understanding:

Allowed Amount

As you study Online, you will come across this term. It refers to the amount of money an insurance company will reimburse for a procedure/service. Whatever is left after the payment will be paid by the patient. However, the allowed amount is different from co-pay or deductibles and should not be confused with either.

AMA

The American Medical Association (AMA) is the biggest consortium of doctors in the US. They also publish a journal known as the American Medical Association. It is considered to be the most widely distributed medical journal globally.

Beneficiary

Another important term taught in the Medical Billing Certification, the beneficiary is the person getting the benefits based on the coverage they signed up under their healthcare plan. It doesn’t necessarily have to be the person paying for the insurance since some parents can also be paying for their young children – the latter being the beneficiaries.

Capitation

At your Medical Technical Institute, you will also learn about capitation, which is the arrangement between an insurance payer and a healthcare provider. Depending on the amount that is decided, the former will be paying a sum to the latter for every patient they treat. Health Maintenance Organizations (HMOs) are the healthcare institutions that usually have capitated arrangements. The objective is to get patients to sign up with an HMO who will reimburse part of the money that a procedure costs. The amount that is paid will be determined by several factors, such as the condition of the patient’s health, how old they are, any family history of all illness, their race, etc.

Civilian Health and Medical Program of Uniform Services (CHAMPUS)

Civilian Health and Medical Program of Uniform Services (CHAMPUS, now known as TRICARE) is also an important term to know for those interested in obtaining a Billing Coding Certification Online. CHAMPUS is the federal health insurance program that has been designed around service members – both active and retired –, their families, and the people who survive them.

Downcoding

Medical Billing and Coding Curriculum will also include the term, Downcoding. It refers to there not being enough evidence for an insurance company to approve of a claim for a certain medical service. A coder might say the medical service was performed but without evidence, the insurance company will remove those codes thereby also reducing the amount they would be paying to reimburse a patient.

Explanation of benefits (EOB)

Billing Coding Certification also involves knowing about Explanation of benefits (EOB). This document explains which services are covered by an insurance company. It is attached to a processed claim and can be used both by the provider and patient. Often EOBs are also used to indicate the reason behind a patient’s claim being denied.

Financial Responsibility

Where to Get Medical Billing and Coding becomes important when you realize how your certification influences your career choices in the future. For instance, financial responsibility is a term that you should be familiar with. It refers to the person or entity who owes healthcare provider money for the medical services the former was rendered. That means a patient and an insurance company can be both financially responsible.

Health Insurance Portability and Accountability Act (HIPAA)

Where Can I Learn Medical Billing and Coding is a question you should spend some time answering. Your course should help know about important terms, such as Health Insurance Portability and Accountability Act (HIPAA). HIPAA is a law that was passed in 1996 but still continues to affect the healthcare industry. It is divided into two titles, of which Title I has been designed to protect the health insurance of workers switching jobs. Title II, on the other hand, is centered on the standards and best practices that all facilities must adhere to, regarding electronic health care.

ICD-9 Codes

Knowing Where To Learn Medical Billing and Coding is important but so is knowing what the ICD-9 codes are. They are understood internationally and represent different medical condition diagnoses. They have been put in place after consultation from physicians and can be used to translate what the former says about a patient’s illness. The billing specialist will translate the diagnosis into ICD-9 codes, which are then added to a claim and processed.

ICD-10 Codes

The ICD-9 Codes were updated in 2014 and the updated version became known as the ICD-10. They work in the same way as their predecessor used to.

There are many Medical Billing and Coding Schools out there but if you want to be the best at your job, then you need to invest in the highest quality of Medical Billing Training available to you! Choose a course that covers all the essential terminologies that a billing specialist should know and you will have won half the battle!

Studying for Medical Coding and Billing Online Exams

Medical Billing Certification Online will only be possible, if you successfully pass the CPC. For that to happen, you will have to excel in several different key areas of study. The most important thing to remember though is not to let yourself get overwhelmed. Whether it is the Medical Billing and Coding Curriculum or the exam booklet that you have in your hand, stay calm, and just do your best!
Areas of Study
Before we begin discussing how you should study for the exam, let us look at the key areas of study. The Medical Technical Institute you enroll at should have made sure that you leave with a thorough understanding of the following:
• Medical terminologies: Whether they are the word roots of prefixes/suffixes, you must be adept at the names given to both medical conditions in patients and the procedures used to treat them
• HCPCS: It is equally important that you know your way around the alphanumeric codes that have been given to supplies and drugs
• Modifiers: In case additional aspects, such as statuses, services, or providers, were involved, a two-digit-long suffix is added at the end of a code. You need to be familiar with those too.
• ICD-10-CM: Being able to navigate this study area would mean you are able to recognize the illness diagnosed by its code
• Evaluation and Management (E & M) Visit Codes: The codes will be different for in- and out-patient settings. It is your job to know which visit codes refer to which setting.
• Anesthesia Section: Different codes for the different types of anesthesia exist. You should be able to differentiate between general, local, and regional anesthesia, as well as, conscious sedation periods.
• Radiology Section: In this case, familiarize yourself with codes used for procedures involving X-rays, MRIs, diagnostic imaging, PET scans, nuclear medicine, and ultrasound
• Path & Lab Section: Being able to know which test is used to which kind of disease and infection is important as well
• Medicine Section: Any other medical specialties besides the ones mentioned above should also be familiar to you
Body Systems
Remember, the right decision regarding Where To Get Medical Billing And Coding Certification will determine how much you learn in class! You should also spend some time learning the basics of the following body systems while prepping for your exam:
• Musculoskeletal System
• Cardiovascular System
• Digestive System
• Reproductive System
• Eye/Ear System
• Integumentary System
• Respiratory System
• Urinary System
• Endocrine/Nervous System
Strategy While Studying For Billing Coding Certification Online
It can seem overwhelming at first. One look at what you might have studied in your Online Classes and you fail to see where you should be starting from! That is completely okay because you are dealing with a huge amount of information. However, once you know about these helpful study techniques, you will be able to retain what you learn easily:
• Billing Coding Certification Online becomes easy to study for when you know where your focus should be. Remember the key ideas and concepts we discussed above? You need to focus on them. How will you sift through all that info to get to the relevant parts? By practicing the review exercises at the end of a chapter or section. Do this before you start a unit, so you will know what to attend to.
• Where Can I Learn Medical Billing And Coding is the most crucial question you will be answering in your career. Therefore, pick a place that prepares you well for subsequent examinations. However, there is something you can do for yourself. Once you have grasped the key ideas, rewrite them in your own words. Once you have done that, you won’t easily forget them because you were able to explain the concepts.
• Regular review of the topics that you studied previously as you learn new ones is important as well. On days you know you won’t be able to study anything new, simply devote some time to go over past lessons. Mark up your textbook as you go along, so you won’t need to go through the whole chapter again and highlights the important parts during your next review.
Managing Your Time When Studying for Medical Billing Certification Exam
Good Medical Billing and Coding Schools will help you develop this habit. Therefore, think carefully when you decide Where To Learn Medical Billing and Coding. For an exam like the CPC, you will be sitting down and working for almost six hours. The ideal objective in this scenario is to answer all 150 questions. However, that might not happen, if you aren’t managing your time well. Therefore, before you begin solving the paper, spend a few minutes breaking it down into more manageable parts. Assign question a fixed block of time and try to solve it during the time you have specified.
How you group the questions will depend on your. For example, you can go with five groups of 30 questions each and solve each block in an hour. Or, you could take 20 minutes for solving 10 questions. The trick is not sticking around once the time limit is over. Simply, skip to the next block of questions. If you don’t do that, there would be no use of dividing up the exam questions. If you thought you can solve 30 questions in an hour but only managed to do 25, don’t sweat it. Just go to the next block and return to this section at the end. You stand a better chance of solving questions if you manage your time this way!
Medical Billing Training isn’t hard to ace. You just need to know which study areas to focus on and have a strategy to remember what you learned during your course. Follow the tips mentioned here and you will do fine! Do you have any tips to add to the list? We’d love to hear what you have to say. Just leave a comment below in the comment section. Thanks for dropping by!

FAQs for a Career Before You Sign Up for Medical Coding and Billing Online

Q. Before I enroll for Medical Billing Certification Online, I want to know what a Medical Biller and Coder does while on the job?
A. If you are a Medical Biller or Medical Coder, your duties would entail managing insurance data and health information of the patients of your employer. Keeping this information organization might involve analyzing patient charts, doing medical coding, dealing with issues of insurance reimbursement, entering payment information into a database, and handling claims adjustment.
The codes you will use will come from the International Classification of Disease (ICD-10). In the U.S. health system, the medical codes are used to describe the patients’ diagnoses in seven-character alphanumeric codes. Of course, depending on who you work for, such as a hospital or a physician’s office, you could be dealing with different codes.
Q. I want to know more about the Medical Billing and Coding Curriculum, such as what is the difference between AAPC & AHIMA?
A. The American Academy of Professional Coders or AAPC is the governing body when it comes to the medical coding profession. If you intend to become a medical coder, you will need the AAPC to certify you. Once that is done, you will be able to work in various medical settings, including the hospital outpatient facilities, physician offices, payer organizations, and ambulatory surgical centers. In order to remain AAPC certified, you will adhere to the Code of Ethics that they have outlined for all medical coders. This ensures that you work with complete professionalism, demonstrate integrity, and behave ethically.
The American Health Information Management Association or AHIMA, on the other hand, is related to professionals in the field of health information management (HIM). Being a member of the AHIMA would mean you will have to uphold the standards they have outlined for effective HIM. That’s because without HIM, US citizens won’t have access to quality healthcare. AHIMA is responsible for ensuring that healthcare remains up to date in an age of increasing electronic and globalization. By being a part of it, you will be joining other HIM leaders. As a coding student, you can pursue the AHIMA certification i.e. the Certified Coding Associate (CCA) certification.
Q. Before I join a Medical Technical Institute, I want to confirm if I will find a job upon graduation?
A. If you are thinking of becoming a medical biller or a coder, there is good news for you. The U.S. Department of Labor’s Occupational Outlook Handbook reports that these careers and other similar ones for jobs concerned with medical records and HIM will grow by 13 percent. Even better is that the projection has been predicted to last all the way into 2026! If you look at the other occupations given in the handbook, you will discover that medical billing and coding careers have one of the fastest growth rates.
Q. Before I decide Where to Get Medical Billing and Coding, I would like know the difference between the CPC and the CCS?
A. The Certified Professional Coder (CPC) is a designation. Once you have take the test through the AAPC and passed it, you become a CPC. Keep in mind that the test for CPC won’t include many questions on inpatient coding like the Certified Coding Specialist (CCS) does. Instead, it will have questions focused on physician based coding.
You become a CCS when you pass the test through AHIMA. To get the CCS designation, you will be giving an exam centered around inpatient coding. If you intend to work for a hospital, then you should go for the latter designation (the CPC-H). As you can see, there are opportunities for medical coders to gain specialty coding certifications through the associations of AHIMA and AAPC.
Q. Once I have received my Billing Coding Certification Online, who will I be working for?
A. As both a Medical Coder and Biller, you are eligible for jobs at clinics, doctor’s offices, and hospitals. Even better is the fact that you can also work for yourself. Your capabilities will decide which job you are most suited to.
Q. What hours do medical billing and coding specialists keep at work?
A: Once you have completed your Online Classes, you can apply as a medical billing and coding professional to any hospital, clinic, or doctor’s office. Depending on the type of medical setting you work in and your employer, you could be working the typical 9 a.m. to 5 p.m. shift. Even so, it is better to ask this of your potential employer when you go in for the interview. While working at a hospital, you might be required to work night shifts. Therefore, it is better to be well informed before taking up a job.
Q. Is being a medical billing and coding professional after receiving Billing Coding Certification Online a rewarding career path?
A: One of the best things about becoming a medical billing and coding professional is the freedom that you will enjoy at work. As a pro, you will be given a high level of independence. You will also be working solo most of the time. So, you won’t be hindered by delays by team members or waiting for approval etc. Another good thing is the variety that comes with this job. On some days, you will be doing detective work to figure out which medical code you should be using and why. On other days, you could be dealing with the clients. Then there will be days of data entry. If you pay attention to small details, then this job is perfect for you. Lastly, what you will do as a medical biller or coder will improve people’s lives.
Q. Where Can I Learn Medical Billing and Coding if I do not have a medical background?
A. The good news for all aspiring students wanting to join Medical Billing and Coding Schools is that to qualify for Medical Billing Certification, you do not need any prerequisites, such as a medical background.
Therefore, if you have been thinking of getting into Medical Billing Training and about Where To Learn Medical Billing and Coding, it is time you got started. A career as a medical biller and coder awaits you!

4 Careers After Completing Medical Coding and Billing Online

You are about to graduate from your Medical Billing Certification Online. What do you intend to do next? Have you been thinking about getting a job? Did you manage to take out some time in the middle of your exams and studies to consider your career arc? Don’t fret if you haven’t done that yet. If you sit down and think, you will begin to see that your future is wide open. You don’t just have a chance to obtain your dream job in medical billing and coding. You have additional options that you could be pursuing once you have received your certifications from a Medical Technical Institute.

Medical Billing and Coding Curriculum covers many bases, which is why you have an opportunity to look to other options than a career in prospective billing and coding. The following career options are ready for you to explore. We have tried choosing jobs that offer salaries in the same range as a medical billing and coding job would. We have also ensured that they have similar educational requirements to the ones you possess. Lastly, these jobs are set in work environments akin to the ones you would have worked in as a medical biller or coder.
Think of your certification in medical billing and coding like a starting point. Use it as a diving board that launches you into alternative careers in clinical or health administration settings.

Medical Assistant

Think twice and then think some more when deciding Where to Get Medical Billing and Coding education. That’s because your background could get you the job of a medical assistant if you don’t go for a career in medical billing and coding. To land such a job, you will need to have a professional diploma or postsecondary certificate. If you fulfill those educational requirements, you will be able to work as a medical assistant at a physicians’ office or a clinic. Your duties can include scheduling appointments, keeping the medical records current, assisting the doctor during medical exams, collecting lab test materials, and administering medication to patients with a physician present.

Health Information Technician

Where Can I Learn Medical Billing and Coding is an important question because it can make you eligible for the job of a health information technician. As one, your duties would include keeping patient health data organized. You will also be using classification systems to enter information into registries and databases on paper. Medical Billing Certification endows you with many soft skills. During your training, you learn how to review a huge amount of information from records and do it with complete accuracy. It also helps you become adept at entering important information for storage and analysis into electronic databases. As a health information specialist, you will also have to stay in touch with various healthcare professionals, such as registered nurses and doctors. Your skills will come to your aid when you need to confirm information while also ensuring that the medical records remain accurate and complete.
One of the specializations that will be available to you as a health information technician would be to become a Cancer Registrar. The job of a cancer registrar is reviewing patient records and reports. They are in charge of making sure that the records are accurate and the treatment given to cancer patients is kept track of.

Medical Claims Processor

If you have completed your Billing Coding Certification Online or received your Medical Billing Training, then you can also consider the career of a medical claims processor. As one, your duties