If you are serious about making medical billing and coding a career then you will have to go through extensive training programs from a college or vocational school. Some medical billing programs are able to be completed within a year or less, even if you make the decision to work on a full time basis while completing a medical billing program.
Many of the medical billing and coding training programs have educational requirement that must be met prior to being enrolled. The main requirement includes having either a High School Diploma or a General Educational Diploma (GED). There are other entrance requirements that will need to be met and you should contact the school for more information on what their requirements are. So what type of subjects will you have to study once you are accepted into a medical billing and coding training program?
Some of the more common subjects are:
- Paper claims processing
- Health insurance policies
- CMS 1500 forms
- Medical billing office management
- Understanding medical codes
- Filing and understanding insurance claims
- Medical billing programs and software
- Workers compensation programs
Paper Claims Processing
Having an understanding of medical insurance invoicing and how the system works when it comes to Health Maintenance Organization (HMO) plans and Preferred Provider Organization (PPO) plans work can be difficult. However, regardless of how difficult it may be it is important for healthcare providers to be paid either by the patient or through their insurance plan in a manner that is not only quick but efficient. This is where your job as a medical insurance biller and coder comes in; you are a critical step in the process of ensuring that the physician is paid on schedule.
You will learn how to evaluate a medical insurance invoice and you will also participate in hands-on experience for posting patient payments, data processing, speaking with billing service providers and constructing financial reports.
Health Insurance Policies and CMS 1500 Forms
Throughout your medical billing program you should be provided with instructions and updates in the various health care programs and polices available. Special attention should be given to the following:
- Medicaid
- Medicare
- Personal injury claims
- Group health coverage
- Workers compensation programs
CMS 1500 forms should be accurately filled out and detailed instruction should be given in your programs. You should also be trained in how to spot errors quickly and fix them.
Understanding Medical Billing Codes and Working with Billing Software
A key part of your job will understand medical billing, how to define it and use medical codes on the forms you file with the insurance company. Regardless of the program you choose to enter, it should include a study in current procedural technology (CPT) and international classification of disease coding (ICD). Medical billing and coding software training will include teaching you how to enter in new patient information into a medical database and the various procedures that you will have to follow in order to create a transaction within the software accurately. On top of this you will be given training on how to build reports using this type of software.
Worker’s Compensation and Insurance Claims:
- Workers compensation claims will include a study of
- Medical claims
- CMS 1500 form completion for federal workers
- Medical appeals, adjustments and adjudications
- Claim compensation filing
- Fraud and abuse recognition
The training discussed above will also fall along the same lines as the training for insurance claims. You will learn how to collect claims and submit them. You will also be trained in posting, receiving payments and completing electronic and paper insurance claim forms.
Medical Billing Office Management
Lastly, there may come a time as a medical billing and coder there will come a time when you will be called upon to manage the daily operations within the office. You should be trained in verifying insurance cards, using basic math to calculate insurance deductibles and co-payments and basic medical terms. You will also be schooled in how to properly manage scheduling of patients so that the daily running of the medical practice runs smoothly.