Part I: Medical Terminology
Unit I: Organization of the Body
* . Introduction
A. The body system
B. Body cavities
C. Divisions of the back
D. Planes of the body
Unit II: Structure and Components
of Medical Terms
A. Diagnostic suffixes
B. Procedural suffixes
C. Combining forms
D. Prefixes
Unit III: Terminology of Body Systems
A. Circulatory system
B. Digestive system
C. Endocrine system
D. Reproductive system
E. Muscuskeletal system
F. Nervous system
G. Respiratory system
H. Skin and sense organs
I. Urinary system
Part 2: Coding Procedures
Unit I: CPT and HCPCS
* . Introduction
A. Definition and function of
CPT and HCPCS
B. Abbreviations and symbols
C. Methods of payment
*. Evaluation and Management
A. Factors and levels of
E/M service
B. E/M coding
* Documentation
* Using the CPT code book
A. Symbols
B. Modifiers
C. Locating and using the proper code
D. All inclusive codes
E. coding for multiple procedures
F. modifier codes
G.Determining RVS conversion factors
Unit II: Diagnostic Coding
* ICD-9-CM coding
A. Format of ICD-9-CM
B. Volume I: Tabular List
C. Volume II: Alphabetic Index
D. Appendices
* Coding Guidelines
A. Abbreviations, punctuations
and symbols
B. Using 3, 4, and 5 digits
C. E codes
D. V codes
* Diagnostic Related Groups (DRG)
Part 3: Medical Billing
* Medical Insurance Overview
Unit I: The Career of the Medical
Insurance Biller
A. Job competencies Unit II
B. Types of employment
C. Ethical principles related to claims processing
D. Professionalism
E. Continuing education
Unit II: Guidelines for Handling
Medical records
A. Patient confidentiality
B. Records accuracy, readability
and completeness
C. Documentation
D. Release of information
E. Retention of records
F. Signature authorization
Unit III: Legal Issue Involving Medical
Claims and Records
A. Patient/physician/provider
contracts
B. Assignment of benefits
C. Time limits
D. Insurance claims fraud and
abuse
E. Medical professional liability provisions
Unit IV: The Insurance Policy
A. General policy provisions
B. Coordination of benefits
C. Types of policy limitations
D. Case management provisions
E. Co-payment and deductible provisions
Unit V: Common Types of Coverage
A. Group
B. Individual
C. Prepaid health plans
Unit VII: Basic Process of Handling
Medical Insurance Claims
A. The patient information record
B. The claim form
C. Submitting and tracing claims
D. Insurance claims register
* Insurance Billing Procedures
Unit I: Health Care Payer Procedures
A. HMO’s, PPO’s, and IPA
B. Blue Cross/Blue Shield
C. Medicare and Medicaid
D. CHAMPUS and CHAMPVA
E. Worker’s Compensation
F. Disability
Unit II: Types of Forms
A. Universal CMS-1500 Form
B. Physician’s Report (Worker’s
Compensation)
C. Superbill
D. Practitioner Invoice (Medicaid)
E. Balance letter to patient
F: UB-92 (Blue Cross Blue Shield)
Unit III:Guidelines for Acceptability
A. Accuracy
B. Legibility
C. Completeness
D. Signatures
Unit IV:Claims Processing
A. Paper and Electronic Claims
B. EOB
C. Reasons for Rejection
D. Refilling Procedures
