Transcript Medical Insurance Billing

Medical Insurance Billing
What it is
What it isn’t
Medical Billing is:
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Obtaining insurance information.
Verifying insurance coverage.
Making patient appointments.
Gathering medical information.
Maintaining the privacy of that information.
Transferring Diagnostic and Treatment
information into highly-specialized codes.
Medical Billing Is:
• Transferring insurance information, patient
information and coded diagnosis and
treatment information to a standard billing
form or format.
• Following up with insurers for tracking of
payments.
• Posting credits of payments made by
insurance and patients.
Medical Billling Is NOT:
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It’s not a get-rich quick scheme.
It’s not just sending invoices.
It’s not just billing the patient.
It’s not just billing one way for all
insurances – they are all different.
• It’s not usually a way to work at home.
• It’s not something you invest money in!!
Medical Billling Is NOT:
• It’s not a single class subject -- it’s a whole
curriculum of subjects.
• It’s never the same old thing!
Welcome to challenge of
Medical Billing!
Once you think you know what you are doing,
the codes and the insurance rules change
and you are back in the learning curve at
least once a year!
But so are all other medical billers!
Subjects Covered
• Medical Information and the Law.
Confidentiality, HIPAA, Malpractice, Fraud
and Abuse.
• The medical claim cycle – appointment to
payment audit.
• Insurance Terminology, Insurance Plans.
• Medical and Financial Documentation: the
Chart Notes, the Superbill and the Ledger.
Subjects Covered
• Coding of Diagnostic information (ICD-9CM coding).
• Coding of Treatment Procedures and
Supplies (CPT and HCPCS coding).
• Completion of the CMS-1500 claim form
data elements.
Subjects Covered
• Private Insurance Plans.
• Government Health Plans (Medicare,
Medi-Cal, Tricare, ChampVA)
• Funding structures: Fee-for-service versus
Capitation.
• Provider contracts.
• Reading the Insurance Explanation of
Benefits.
Subjects Covered
• Write-off/adjustment amounts and balance
billing.
• Coordination of Benefits between multiple
insurances.
• Patient Advocacy.
• Collections.
• Job Search strategies.
Subjects Not Covered
• Medical Terminology is a required skill that
is offered in either a lecture class or a
computer-based self-study module course.
• Medical Assisting (Back-Office) is a
complimentary, but different course.
• Hospital Facility Billing is beyond the
scope of a course in physician billing. (We
will, however, look at the concepts behind
facility charges and the UB-04.)
Books You Will Use:
• PURCHASE:
• Course Text Book (see
the syllabus or ask for the
book in the student
store).
Mandatory References:
• International
Classification of
Diseases, Revision 9
(ICD-9-CM – Recent
Edition!).
• Current Procedural
Terminology (CPT)
Recent Edition!.
• Medical Dictionary
(Optional).
This Course IS:
• A way for beginners to learn about and
enter the field of Medical Insurance Billing.
• A way for medical billers to gain additional
skills and prepare for certification.
• A way for medical professionals to
understand the billing process.
• A way for patients and families of patients
to understand their insurance and their
rights.
About This Course:
• This isn’t a self-study course, and students
will need to attend lectures and turn off cell
phones and refrain from chatter during
lecture times.
• This isn’t a guarantee you will find a job,
but it should give you job skills.
• This school does not have an “externship”
program, so volunteering or networking
are suggested to get into the job market.
Participation
• All students are encouraged to raise their
hands when they have personal
experiences to share or questions to ask.
• If you cannot hear your instructor, please
sit in the front row or raise your hand and
ask the instructor to speak UP!
• This is your course, make every minute
count!
Courtesy Rules
• All cell phones must be off or turned to
vibrate.
• Students may not smoke on campus.
• Questions are welcomed ONLY if a
student raises his/her hand and is
recognized before speaking.
• Cross-talking while the instructor is
lecturing or during a test is PROHIBITED.
Student Conduct
• Unexcused absences: Students will be dropped
if they have more two consecutive absences
without contacting the instructor and/or obtaining
a physician’s note.
• Students who cross-talk during class will be sent
home on second warning.
• If a student must be sent home a second time
due to cross-talking they will be dropped due to
unexcused absence.
This Course is NOT a competition!
Everybody is a winner as long as they are
courteous, attend lectures and labs, do the
projects and the homework and take the
quizzes.
Class Resources Website:
www.mediclaimclass.net