Medical Billing and Coding
I. Introduction to Medical Billing and Coding
A. Personal Qualifications
B. Career Opportunities
C. Certifications
II. Healthcare Law
A. HIPAA Privacy Rule and Security Rule
B. Protected Health Information
C. Fraud and Abuse
D. Stark Law
E. False Claims Act
III. Introduction to Health Insurance Terms
A. Health Insurance Terms
B. Managed Care
C. Healthcare Provider Terms
D. Third-Party Reimbursement Methods
IV. Pharmacology for Coders
A. Definition of Pharmacology
B. Generic and Brand Names
C. Drug Classifications
D. Therapeutic Uses of Medications
E. Routes of Administration
F. Formularies
G. Medication Lists
V. ICD-10-CM
A. Overview of ICD-10-CM
B. Format of ICD-10-CM
C. ICD-10-CM Coding Guidelines
D. ICD-10-CM Coding Conventions
E. Steps for Assigning ICD-10-CM Codes
VI. CPT and HCPCS Level II Coding
A. Healthcare Common Procedure Coding System
B. Organization of the CPT Code Book
C. CPT Coding Conventions
D. Organization of the HCPCS Level II Code Book
E. Steps for Assigning CPT and HCPCS Level II Codes
VII. Abstracting Information from Medical Documents
A. Coding from SOAP Notes
B. Coding from a Consultation Report
C. Coding from Operative Reports
D. Coding from Emergency Room Records
E. Coding from Procedure Reports
VIII. New Patients, Insurance Claims and EOBs
A. Electronic, Paper and Hybrid Medical Records
B. Practice Management Software
C. Patient Portal
D. Developing an Insurance Claim
E. New Patient Procedures
F. Medical Necessity
G. Explanation of Benefits (EOB)
H. Collection Practices
IX. Submitting Electronic Claims and CMS 1500
A. Electronic Data Interchange (EDI)
B. Electronic Claims Submission
C. 1500 Claim Form
D. National Uniform Claim Committee
X. Blue Cross/Blue Shield
A. Participating and Nonparticipating Providers
B. Allowable Fee
C. Usual, Customary and Reasonable (UCR)
D. Blue Shield Claims Submission
XI. Medicare
A. Medicare Parts A, B, C and D
B. Participating and Nonparticipating Providers
C. Advance Beneficiary Notice (ABN)
D. Supplemental Insurance
E. NCCI
F. Medicare Claims Submission
XII. Other Healthcare Programs
A. Medicaid
B. TRICARE
C. CHAMPVA
D. Workers' Compensation
E. Claims Submission
XIII. ICD-10-PCS
A. Overview of ICD-10-PCS
B. ICD-10-PCS Code Structure
C. Index and Table Conventions
D. Code Components
E. Definitions Used in ICD-10-PCS
XIV. Survey of Hospital Billing
A. Hospital Revenue Cycle
B. Chargemaster
C. Master Patient Index
D. Prospective Payment Systems
E. Principal Diagnosis
F. Present On Admission

Medical Terminology
I. A Foundation in Medical Terminology
A. The Fundamentals of Medical Terminology
B. Overview of the Human Body
C. Practicing What You've Learned
II. The Skeletal and Muscular Systems
A. Overview of the Skeletal System
B. Overview of the Muscular System
C. Practicing What You've Learned
III. The Cardiovascular and Respiratory Systems
A. Overview of the Cardiovascular System
B. Overview of the Respiratory System
C. Practicing What You've Learned
IV. The Digestive, Urinary, and Reproductive Systems
A. Overview of the Digestive System
B. Overview of the Urinary System
C. Overview of the Reproductive System
D. Practicing What You've Learned
V. Nervous and Integumentary Systems and Special Senses
A. Overview of the Nervous System
B. Overview of the Integumentary System
C. Overview of Special Senses
D. Practicing What You've Learned
VI. The Lymphatic, Immune, and Endocrine Systems
A. Overview of the Lymphatic System
B. Overview of the Immune System
C. Overview of the Endocrine System
D. Practicing What You've Learned