Module 1 - Introduction

• Careers as a Medical Biller
• Education and Certification
• Confideniality
• Professional Certification

Module 2 - Insurance Companies

• Introduction
  • What is Health Insurance
• Who is The Insurance Carrier
• Types of Health Insurance Coverage
  • Commercial Carrier
  • The Blue's
  • Medicare
  • Medicaid
  • Champus
  • Workers Compensation
  • Health Maintenance Organization
  • Types of Insurance Plans
  • What is a Contract?
  • The Plan
  • Plan Provision
  • Order of Benefit Determination
  • Birthday Rule
  • Let's Practice
• Who's Who in Insurance Terms
  • Carrier, Coverage and Plan
  • The Contract
• Basic Terms and Definitions

Module 3 - Making an Insurance Claim

• Health Insurance
• What is a Claim
• Forms
• Vital Information
• The Universal Claim Form
• Understanding the Providers Charges
• Usual, Customary, Reasonable (UCR) Payment Plan
• Fee Schedule Payment Plan
• Capitation
• Maximum Fee Schedule
• Releative Value Studies (RVS)
• Types of Payments
• Medical Terminology
• Insurance Terminology
• The HCFA-1500 Standard Data
• Authorization of Benefits
• Developing an Insurance Claim
• A Clean Claim
• IHA Case Study 'Superbill'

Module 4 - Basic Claim Guidlines

• Medical Office Forms
• Guidelines for Billing
• Common Causes for Claim Rejection
• Other Causes for Rejections
• Physician ID Numbers
• Block #17 & 17A: Refering Physician Info
• Block #24K: Special Instruction Field
• Block #33: Attending Physician Info
• A Billing Entity
• *What is a Par Provider?
• What is a NonPar Provider?
• General Diagnosis Reporting
• Reporting Diagnosis Codes on The HCFA-1500 Form
• Maintaining Insurance Claim Files
• Types of Claims
• Medical Office Forms
• Common Errors That Delay Processing
• Other Causes for Rejections
• How to Get Paid Better and Faster
• Physician ID Numbers
• Payer ID - Payer Identifier
• Par VS NonPar
• Diagnosis Reference Numbers
• Using The Insurance Carriers Dollars

Module 5 - Creating a Commercial Claim

• Filing a Commercial Claim
• Commercial Claims Step-by-Step Instructions
  • HCFA - 1500 Form - Top
  • Patient, Insured and Policy Data - Blocks 1 Through 8
  • Blocks 9 Through 13
  • HCFA - 1500 Form - Bottom
  • Diagnostic, Treatment and Provider Identification - Blocks 14 Through 33
  • Claim Detail Lines - Blocks 24A Through 24K
  • Provider and Billing Entity Indentification - Blocks 25 Through 33
• Filing a Commercial Claim II
  • Assignment of Benefits Form
  • Order of Benefit Determination
  • Billing the Prime Insurance with a Secondary Insurance
  • HCFA - 1500 Form - Top
  • HCFA - 1500 Form - Bottom
• Commercial Secondary Claims
  • Blocks to be a Completed on the Secondary Plan Claim
  • Completing the Claims Payment

Module 6 - Creating Medicare Claims

• Creating a Medicare Claim
  • Medicare Eligibility
  • Medicare Health Insurance Card
  • Railroad Retirement Medicare
  • DME Claims
  • Coalminer's Claims
  • Employed Elderly Healthcare Coveragev
  • What is a Medicare Intermdiary?
  • Medicare - Part 'A'
  • Medicare - Part 'B'
  • Medicare Guidelines
  • Part 'B'
  • Part 'A'
  • Participating Providers - Par
  • Non Participationg Providers - Non Par
  • Limiting Charge or Limiting Fee
  • Medicare Part 'B' (2)
  • A Brief History of Meicare Assignments
  • Medicare Supplemental Insurance
• Filing a Medical Claim
  • Medicare as a Primary Payer
  • Special Handling
• Step-by-Step Claim Form Instructions
  • Blocks 1 through 13
  • HCFA - 1500 Form - Bottom
  • Blocks 14 through 33
  • More Information for Block 17 and 17A
  • More Information About Block 19
  • Claim Detail Lines - Blocks 24A through 24K
  • Notes for Block 24D
  • Provider and Billing Entity Identificaion - Blocks 25 through 33
• Medicare and Medigap Crossover Claims
• Medigap for Par Providers Instructions
• Medigap for Par Providers Instructions - Form
• Medicare Secondary Payer (MSP)
• Medicare Secondary Payer (MSP) Instructions
• Medicare Secondary Payer (MSP) - Form
• Medicare and Medicaid Crossover Claims
• Medicare and Medicaid Crossover Claims - Form
• Medicare Intermediary Address

Module 7 - The 'Blues'

• The Blues
  • BC/BS Distinctive Plan Features
  • Types of BC/BS Accounts
  • Indemnity Benefit Contracts
  • Other Typed of Plans Enforce with 'The Blues' ARE:
  • Indentifying Information and ID CArds
  • The Blue Card Program
  • Standard 'Blues' Plan Claims Procedures
• Creating A Blues Claim
• Filing a Blues Claim
  • Electronic 'Blues' Claims Filing Instructions
  • Manual Completion of the HCFA - 1500 Claim Form
  • HCFA - 1500 Form - Top
  • Patient, Insured and Policy Data - Blocks 1 through 13
  • HCFA - 1500 Form - Bottom
  • Diagnostic, Treatment and Provider Data - Blocks 14 through 33
  • Claim Detail Lines - Blocks 24A through 24K
  • Provider and Billing Entity Data - Blocks 25 through 33
• The Blues as a Secondary Insurance Policy Instructions
• Additional Blues Secondary Coverage
• Blue Cross and Blue Shield Addresses
• Blue Cross and Blue Shield Federal Employees Programs
• Explanation of Benefits (EOB)

Module 8 - Creating Champus Claims

• Champus, Champva, and Tricare
• Champus Eligibility
• Who Can Treat a Champus Patient?
• Champus & Champus Identification Cards
• Champus Benefits
• Nonavailability Statement
• Champus Billing Information
• Champus Claims Procedures
• Creating a Champus Claim
• Filing a Champus Claim
  • Champus Claims Step-by-Step Instructions
  • HCFA - 1500 Form - Top
  • Patient, Insured and Policy Data - Blocks 1 thorugh 13
  • HCFA - 1500 Form - Bottom
  • Diagnostic, Treatment and Provider Data - Blocks 14 through 33
  • Claim Detail Lines - Blocks 24A through 24K
  • Provider and Billing Data - Blocks 25 though 33
• Champus EOB and Payment Voucher
• Champus Non Availability Statement (NAS)
• Statement of Personal Injury Possible Third Party Liability
• Champus Glossary

Module 9 - Claims Excercises

Appendix I - Insurance Contract #1

Appendix II - Insurance Forms and Letters

Appendix III - Relative Value Study

Appendix IV - Provider and Clinic Data

Appendix V - HCFA Payer ID

Appendix VI - Provider Profile Data

Appendix VII - HCFA-NPI Number

Appendix VIII - Billing Glossary

Appendix IX - Common Medical Diagnoses