📝 Course Description
Medical billing is a vital component of the healthcare revenue cycle, ensuring that healthcare providers are accurately reimbursed for their services. This comprehensive online course equips you with essential knowledge and skills to become a proficient medical biller—ready to work in clinics, hospitals, insurance companies, or remotely from home.
You’ll explore the full billing cycle—from patient registration to final claim submission and payment posting—while gaining hands-on practice with the tools and terminology used in real-world healthcare settings.
🎯 What You Will Learn
• Understand the U.S. healthcare revenue cycle and its key stakeholders
• Master the steps in the medical billing process: pre-billing, claim generation, submission, and follow-up
• Learn about insurance plans (Medicare, Medicaid, private payers) and payer policies
• Navigate claim forms like CMS-1500 and handle denials and rejections
• Understand patient billing, collections, and use of billing software
👥 Who Should Enroll
• Beginners interested in a career in healthcare administration
• Life science graduates exploring alternative careers
• Professionals in non-clinical roles (front desk, reception, transcription)
• Anyone seeking remote or freelance healthcare billing jobs
Curriculum
- 8 Sections
- 43 Lessons
- 47 Hours
- Introduction to Medical BillingRevenue Cycle Management (RCM) is the process healthcare providers use to track and manage the financial aspects of patient care, from the initial appointment to the final payment. It encompasses all administrative and clinical functions that contribute to capturing, managing, and collecting revenue.3
- InsuranceIn medical billing, insurance refers to the agreement where an insurance company (the insurer) agrees to cover a portion of a patient's healthcare expenses in exchange for regular premium payments from the patient (the policyholder).11
- 2.1Introduction50 Minutes
- 2.2What is Health Insurance50 Minutes
- 2.3Types of Patients In Medical Billing
- 2.4What is the Fee Schedule in Medical Billing
- 2.5What are the Types of Providers in Medical Billing
- 2.6What are HMO,PPO & POS
- 2.7Place of Service & Types
- 2.8Medicare
- 2.9Medicade
- 2.10Tricare
- 2.11Workers Compensation Insurance
- Payment Posting7
- Clearing HouseA medical billing clearinghouse is a third-party service that acts as a go-between for healthcare providers and insurance companies. It streamlines the claims process by receiving, reviewing, and forwarding medical claims electronically, ensuring accuracy and compliance before submitting them to payers for payment.4
- Adjudication ProcessIn medical billing, adjudication is the process where a payer (insurance company) reviews a submitted claim to determine whether to pay, deny, or partially pay it. This involves verifying the claim's accuracy, eligibility, and compliance with the payer's policies and contractual agreements.4
- DenialsIn medical billing, a denial occurs when an insurance company refuses to pay for a medical service or procedure that was billed. This rejection is based on specific reasons like errors in the claim, missing information, or policy limitations. Denials differ from rejections, which are typically due to front-end data errors and can be easily corrected and resubmitted10
- 6.1Introduction
- 6.2Types of Denials
- 6.3Claim Denials Based on Eligibility or Coverage
- 6.4Claim Denials Based on Administrative Errors
- 6.5Claim Denials Based on Financial or Contractual Issues
- 6.6Claim Denials Based on Timeliness
- 6.7Claim Denials Based on Patient Responsibility
- 6.8Claim Denials Based on Incorrect Billing or Coding
- 6.9Claim Denials Due to Documentation Issues
- 6.10How to Handle Denials in Medical Billing:
- Modifier & CPTIn medical billing, CPT codes (Current Procedural Terminology) describe the specific medical, surgical, or diagnostic services provided, while modifiers are two-character codes (either numeric or alphanumeric) appended to CPT codes to provide additional information about the service. Modifiers don't change the fundamental service described by the CPT code, but they clarify circumstances like location, multiple procedures, or unusual events.4
- Common Key TermsKey terms in medical billing include deductibles, co-pays, co-insurance, and out-of-pocket maximums, which are all related to patient cost-sharing with their insurance plan. Additionally, CPT codes, ICD-10 codes, and HCPCS codes are crucial for accurately reporting procedures and diagnoses. Understanding terms like EOB (Explanation of Benefits), ERA (Electronic Remittance Advice), and ABN (Advance Beneficiary Notice) is also vital for navigating the billing process.0
