• Email: [email protected]
• Phone: (888) 889-2840

Additional Cost Description:

None

Upon completion of this course, students will be able to...

• Describe the phases of the revenue cycle and gain an understanding of basic insurance terminology
• Describe healthcare opportunities and certification for the insurance specialist
• Discuss some different managed care plans
• List various healthcare benefits and insurance plans
• Define the different phases of the revenue cycle and related tasks
• Demonstrate knowledge of confidentiality and billing laws, regulations, and standards
• Identify laws and regulations that apply to the insurance specialist
• Describe use of the electronic health record and types of documentation
• Distinguish the similarities and differences of HIPAA and HITECH
• Define protected health information
• Explain the role of the Office of Inspector General
• Define written, informed, and implied consents
• Determine what constitutes fraud and abuse
• Explain verification of patient financial responsibility and insurance information
• Recognize the difference between new and established patients
• Explain the collection of insurance data, verification, and eligibility
• Determine information necessary to establish financial responsibility
• Discuss eligibility, in-network and out-of-network coverage, preauthorization, and predetermination
• Describe the dependent, gender, and birthday rules
• Define assignment of benefits, time-of-service payments, and advance beneficiary notice
• Differentiate government and commercial insurance plans and determine which is primary
• Apply ICD-10-CM, CPT, and HCPCS codes and modifiers based on coding guidelines
• Explain the purpose and use of the ICD-10-CM manual, alphabetic index, and tabular list
• Discuss the organizations responsible for publishing and updating the ICD-10-CM code set
• Identify the difference between main terms, subterms, and nonessential modifiers in the ICD-10-CM alphabetic index
• Define chapter structure, categories, and subcategories in the ICD-10-CM tabular list
• Apply introductory diagnosis coding skills
• Identify the conventions in the ICD-10-CM alphabetic index
• Discuss the impact of instructional notations with diagnosis coding
• Explain General Evidence Mapping (GEM)
• Describe the six steps to assign a diagnosis code and the impact of coding guidelines
• Assign and sequence diagnosis codes correctly based on abstraction of data
• Explain the purpose and use of the CPT manual guidelines, index, and sections
• Discuss the organization responsible for publishing and updating the CPT code set
• Identify the difference between main terms and modifying terms in the CPT index
• Define CPT format, symbols, and modifiers
• List the main sections of the CPT manual
• Describe the steps to assign a procedure code
• Apply introductory procedure coding skills
• Explain the purpose and use of the HCPCS manual
• Discuss the organization responsible for publishing and updating the HCPCS code set
• Describe the steps taken to assign a HCPCS code
• Compare and contrast CPT and HCPCS codes
• Apply Introductory HCPCS coding skills
• Identify billing compliance errors with coding, code linkage, medical necessity, and the revenue cycle
• Identify strategies for successful billing compliance including use of payer coding screens
• Describe internal and external auditing requirements
• Differentiate provider and payer fee schedules
• Explain payment systems including RBRVS, fee-based, contracted, capitation, and time-of-service
• Explain the difference between CMS-1500, HIPAA 837P, UB-04/CMS-1450, and HIPAA X12 837I claims
• Complete CMS-1500 claim blocks and discuss claim submission
• Detail completion of the HIPAA 837-P claim and electronic data interchange
• Describe the use of a clearinghouse versus direct transmission of healthcare claims
• Identify the use of the UB-04/CMS-1450 claim and the code sets utilized for institutional billing
• Differentiate between group, private, and commercial healthcare insurance plans
• Compare and contrast preauthorization and precertification
• Explain point-of-service, indemnity, medical home, and consumer driven private payer options
• Discuss the Patient Protection and Affordable Care Act (PPACA)
• Transmit HIPAA 837P electronic claims accurately and successfully
• Describe the parts of Medicare, eligibility, coverage, and benefits
• Explain the differences between Medicare participating and nonparticipating providers
• Discuss the various Medicare plans including original, advantage, fee-for-service, and Medigap
• Define Program Integrity Contractor
• Transmit electronic Medicare claims accurately and successfully
• Identify the components of the Medicare Summary Notice (MSN)
• Describe Medicaid eligibility, coverage, and benefits
• Discuss covered and noncovered services for the Medicaid recipient
• Define Federal and State Medicaid Programs
• Explain the Medicaid Integrity Program
• Distinguish the claim submission process versus the claim follow-up process
• Transmit electronic Medicaid claims accurately and successfully
• Describe the TRICARE program and eligibility
• Identify the types of TRICARE coverages
• Discuss the CHAMPVA program and eligibility
• Identify covered services for TRICARE and CHAMPVA and DEERS user
• Explain the claims process for TRICARE and CHAMPVA
• Transmit electronic claims accurately and successfully
• Differentiate the Federal and State roles in Worker’s Compensation
• Discuss eligibility for Worker’s Compensation and documentation requirements
• Explain Worker’s Compensation billing and claim management
• Describe Disability, Automotive, and Homeowner’s plans and requirements
• Transmit electronic claims accurately and successfully, applying the correct filing order
• Identify and discuss the five steps in the claim adjudication process
• Identify approaches used to manage claim status
• Recognize that aging reports are used to determine the necessity for payer inquiries
• Explain the remittance advice, adjustment codes, takebacks, and withholds
• Describe posting and applying payments and when to use the appeal or grievance process
• Discuss Medicare, TRICARE, and Medicare/Medicaid crossover and secondary claims
• Determine financial responsibility and define guarantor
• Explain patient statements and the billing cycle
• Discuss collection procedures including regulations, credit and payment laws, and payment plans
• Describe when to use collection agencies and credit reporting requirements
• Differentiate posting payments, account write-offs, and bad debts

Lesson 1 – The Insurance Specialist and Revenue Cycle

Lesson 2 – Using and Protecting Health Information

Lesson 3 – The Patient Encounter

Lesson 4 – An Overview of the ICD-10-CM

Lesson 5 – Instructional Notations of the ICD-10-CM

Lesson 6 – Introduction to CPT

Lesson 7 – Introduction to HCPCS

Lesson 8 – Encounter Charges and Billing

Lesson 9 – The Healthcare Insurance Claim

Lesson 10 – Private and ACA Health Insurance

Lesson 11 – Medicare

Lesson 12 – Medicaid

Lesson 13 – TRICARE and CHAMPVA

Lesson 14 – Other Compensation Plans

Lesson 15 – Health Insurance Claim Follow-up

Lesson 16 – Billing and Collections

Students will require a computer device with headphones, a microphone, webcam, up-to-date Chrome Web Browser, and access to YouTube. MedCerts programs require a PC, Mac, or Chromebook device, with a standard high-speed internet connection. Google Chrome is the preferred browser for training. Please note, while some activities may work on a mobile device or tablet, MedCerts programs are not designed to be used on these devices. Mobile devices and tablets are therefore not considered supported devices.

Ensure that your school or district network and device administrator establishes network access permissions or exceptions for online resources relevant to the course in which you are choosing to enroll. Ref., Michigan Virtual Course Allow List

Please review the Michigan Virtual Technology Requirements.