The Medical Billing & Coding program is a 340-clock hours hybrid course designed to equip students with the skills and knowledge required to fulfill a position as an Insurance Billing Specialist. The curriculum includes an introduction to diagnosis coding (ICD-9 and ICD-10), procedure coding (CPT and HCPCS), billing and reimbursement processes, and understanding insurance companies. Additionally, the program covers Medical Insurance Billing as a Career, HIPAA & HITECH, Health Insurance basics, Medical Record Documentation, Electronic Data Exchange, Claim Reimbursement, Fees, BCBS, Managed Care, Private Insurance, Medicare, Medicaid, Tricare, CHAMPVA, Workers’ Compensation, and Disability Income Insurance. Upon completion, students will be proficient in roles such as Billing Clerks, Medical Records Specialists and Medical Coders.
Certified Billing and Coding Specialist (CBCS)
After completing this program, graduates will be able to:
• Understand health insurance terms and those used by healthcare providers, including managed care and third-party reimbursement methods.
• Understand the definition of pharmacology, generic and brand names, drug classifications, formularies, medication lists, therapeutic uses of medications, and routes of administration.
• Understand the Healthcare Common Procedure Coding System, organization of the CPT and HCPCS Level II code books, coding conventions, and steps for assigning codes.
• Code from SOAP notes, consultation reports, operative reports, emergency room records, and procedure reports.
• Navigate through electronic, paper, and hybrid medical records, practice management software, patient portals, and developing insurance claims.
• Submit Electronic Claims and CMS 1500
• Identify Medicare Parts A, B, C, and D, participating and nonparticipating providers, Advance Beneficiary Notice (ABN), supplemental insurance, NCCI, and Medicare claims submissions.
• Use the ICD-10-PCS code structure, index and table conventions, code components, and definitions used in ICD-10-PCS.
• Understand hospital revenue cycle, chargemaster, master patient index, prospective payment systems, principal diagnosis, and present on admission
Certified Medical Billing & Coding Course Syllabus (340 Hours, 18 Weeks)
Course Overview
• Total Hours: 340
• Weeks: 18
• Weekly Hours: 18-19 hours of instruction
• Delivery Method: In-person / Online
• Objectives: To prepare students for certification in medical billing and coding, with a focus on medical terminology, anatomy, billing and coding systems, healthcare regulations, and electronic health records.
Weekly Breakdown
Week 1: Introduction to Medical Billing & Coding (18 Hours)
• Course Orientation
• Overview of the U.S. Healthcare System
• Introduction to Medical Billing and Coding Profession
• Ethics and Compliance in Billing and Coding
Week 2: Medical Terminology I (18 Hours)
• Basic Medical Terminology
• Roots, Prefixes, Suffixes
• Abbreviations Commonly Used in Medical Records
Week 3: Medical Terminology II (18 Hours)
• Advanced Terminology by Body Systems
• Practice Exercises with Case Studies
• Terminology for Pharmacology
Week 4: Anatomy & Physiology I (18 Hours)
• Overview of Body Systems
• Musculoskeletal System, Cardiovascular System
• Coding for Anatomy-Related Cases
Week 5: Anatomy & Physiology II (18 Hours)
• Nervous, Respiratory, Digestive Systems
• Practice Coding with Sample Cases
• Anatomy Terminology in Coding Context
Week 6: Introduction to Coding (18 Hours)
• Introduction to ICD-10-CM, CPT, HCPCS Level II
• Understanding Coding Guidelines and Format
• Coding Exercises and Case Studies
Week 7: ICD-10-CM Coding (18 Hours)
• ICD-10 Coding Guidelines
• Practice Coding Diagnosis Codes
• Using Coding Manuals and Software
Week 8: CPT Coding (18 Hours)
• Current Procedural Terminology (CPT) Guidelines
• Categories of CPT Codes
• Practice CPT Coding Scenarios
Week 9: HCPCS Level II Coding (18 Hours)
• Introduction to HCPCS Level II Codes
• Coding for Durable Medical Equipment and Supplies
• Case Studies for HCPCS Level II
Week 10: Coding for Specialized Areas (18 Hours)
• Obstetrics, Gynecology, Cardiology
• Surgery and Anesthesia Codes
• Practice Specialized Coding Scenarios
Week 11: Medical Billing Process (18 Hours)
• Patient Registration, Insurance Verification
• Claims Submission Process
• Billing for Services and Supplies
Week 12: Insurance and Reimbursement (18 Hours)
• Types of Insurance Plans (Medicare, Medicaid, Private)
• Third-Party Payer Requirements
• Understanding EOBs (Explanation of Benefits)
Week 13: Revenue Cycle Management (18 Hours)
•Overview of Revenue Cycle
•Denial Management and Appeals
•Collection Strategies and Patient Billing
Week 14: Health Information Technology (18 Hours)
•Electronic Health Records (EHR) Systems
•Practice Management Software
•Data Privacy and HIPAA Compliance
Week 15: Regulatory Compliance and Ethics (18 Hours)
•HIPAA, Fraud, and Abuse
•Compliance Programs and Audits
•Ethical Issues in Billing and Coding
Week 16: Advanced Coding and Problem Solving (18 Hours)
•Complex Case Scenarios
•Coding Modifiers and Medical Necessity
•Problem Solving and Review
Week 17: Certification Exam Preparation (18 Hours)
•Review of Key Topics
•Practice Exams and Test-Taking Strategies
•Focus on Weak Areas
Week 18: Final Exam and Wrap-Up (18 Hours)
•Comprehensive Final Exam
•Course Evaluation and Feedback
•Career Resources and Certification Application Process
