Online Career Training
Medical Billing and Coding Course
Medical Billing & Coding Class Outline
Why choose NYICD?

Our online Medical Billing and Coding Course prepares you to pass the CBCS exam from the National Healthcareer Association.

Healthcare is the fastest growing industry in the United States, and with your medical billing and coding certification, you’ll be ready to join the workforce.

Course Description

Our Medical Billing and Coding class was developed by industry professionals. Program topics include medical terminology; insurance plans; medical ethics; HIPAA; diagnostic and procedural coding; coding compliance and auditing; physician and hospital billing; Medicare, Medicaid; and workers’ compensation.

Medical Billing and Coding Course Outline

Unit 1: Medical and Body Systems Terminology

1.1 Medical Terminology 

Introduction to basic medical terminology and word formation; identification of the four major word parts of medical terms; building, defining, and analyzing medical terms.

1.2 Body Systems 1 

Discussion of the anatomy and physiology of the integumentary, musculoskeletal, digestive, cardiovascular, lymphatic, respiratory, endocrine, and nervous systems; identification of associated terms, conditions, and abbreviations.

1.3 Body Systems 2 

Discussion of the anatomy and physiology of the urinary and reproductive systems, the specialties of gynecology, obstetrics, and neonatology, and the anatomy of the eyes and ears; identification of associated terms, conditions, and abbreviations.

1.4 Disease Processes and Surgical Procedures 

An overview of the terminology related to major chronic and infectious diseases as well as surgical treatments for those diseases.

Unit 2: Understanding Managed Care

2.1 Introduction to Professional Billing and Coding Careers 

An introduction to the different types of facilities that employ allied health personnel; job descriptions pertaining to billing and coding careers; options available for certification.

2.2 Insurance Plans 

The history and impact of managed care; the organization of managed care and its effect on the provider, employee, and policyholder; patient financial responsibility; types of managed care plans and insurance coverage.

2.3 Medical Contracts, Ethics, and HIPAA 

Key elements of managed care contracts; covered services for patients, including preventive medical services and office visits; protected health information; patient information disclosure; HIPAA security standards and regulations compliance; HITECH and EHRs.

Unit 3: Medical Coding

3.1 ICD-9-CM Coding 

History of coding; purpose of ICD-9-CM; abbreviations, symbols, typefaces, punctuation, and formatting conventions; correct code assignment; nine steps of accurate coding.

3.2 ICD-10-CM Coding 

Similarities and differences between ICD-9 and ICD-10 codes; differences between a crosswalk and mapping; general ICD-10 coding guidelines; new features in ICD-10-PCS.

3.3 ICD-10-PCS Coding 

Guidelines for procedural coding within the hospital setting; comparison to ICD-9-CM Volume 3; an explanation of the analysis, assignment, and sequencing of ICD-10-PCS codes.

3.4 CPT and Place-of-Service Coding; Coding Procedures and Services 

History of CPT; evaluation and management (E/M) services and code assignment; CPT categories; modifiers and add-ons; using the CPT index; code ranges and conventions.

3.5 HCPCS, Coding Compliance, and Auditing 

Two levels of HCPCS coding; modifiers; interpreting and identifying correct code linkages; reviewing codes for accuracy; federal laws, regulations, and penalties pertaining to coding compliance; the National Correct Coding Initiative; medical ethics for coders; implementing a coding audit; reviewing and analyzing medical records; content and documentation requirements.

Unit 4: Medical Billing

4.1 Physician Medical Billing 

Completing medical claim forms accurately, both manually and electronically; defining claim form parts, sections, and required information; the CMS-1500 claim form; reasons why claim forms are delayed or rejected; filing a secondary claim.

4.2 Hospital Medical Billing 

The hospital inpatient billing process; submitting accurate and timely hospital claims and practicing good follow-up and collection techniques; differentiating between inpatient and outpatient services; the UB-04 (CMS-1450) hospital billing claim form.

4.3 Medicare 

Government billing guidelines; determining the amount due from a patient for a participating provider; Medicare fee schedules; completing accurate Medicare forms; identifying types of Medicare fraud and abuse.

4.4 Medicaid and TRICARE 

Requirements for qualifying to receive Medicaid benefits; determining the schedule of benefits a Medicaid recipient will receive; verifying Medicaid benefits; submitting a Medicaid claim and deciphering claim status; determining TRICARE eligibility; types of benefits available to veterans and their families; submitting claims to TRICARE using the CMS-1500 and UB-04 forms.

Unit 5: Accounts Receivable, Injury Claims, and Electronic Claims Processing

5.1 Explanation of Benefits, Payment Adjudication, Refunds, and Appeals 

Steps necessary for filing a medical claim; the importance of the Explanation of Benefits and Electronic Remittance Advice forms; calculating accurate payment by a carrier or third-party payer; making adjustments to patient accounts; reviewing reason codes; common problems and solutions for denied or delayed payments; formatting medical records with proper documentation; registering a formal appeal; ERISA rules and regulations; refund guidelines; rebilling insurance claims; three levels of Medicare appeals; calculating and issuing refunds.

5.2 Workers' Compensation 

The history of workers' compensation; federal workers' compensation versus state workers' compensation; classifications of work-related injuries; injured workers' responsibilities and rights; responsibilities of the treating doctor/physician; the role of an ombudsman; four types of workers' compensation benefits; different types of disability; completing a CMS-1500 form for a workers' compensation claim; determining the workers' compensation fee schedule based on the Medicare Fee Schedule.

5.3 Electronic Claims Processing 

Entering patient demographic information and posting charges, payments, and adjustments using medical practice management software; printing a walkout receipt for each patient who has charges posted to his or her account; balancing the batch at the end of the day; printing insurance claim forms for patients who are covered by insurance.

Unit 6: ICD-10-CM Coding Practice

6.1 ICD-10-CM Coding Practice, Part 1 

Introduction to ICD-10-CM; guidelines and conventions; neoplasms; symptoms, signs, and abnormal clinical and laboratory findings; factors influencing health status and contact with health services; external causes of morbidity.

6.2 ICD-10-CM Coding Practice, Part 2 

Diseases of the digestive system; endocrine, nutritional, and metabolic diseases; diseases of the skin and subcutaneous tissues; diseases of the musculoskeletal system and connective tissue; injury, poisoning, and certain other consequences of external causes.

6.3 ICD-10-CM Coding Practice, Part 3 

Diseases of the circulatory system; diseases of the blood and blood-forming organs; diseases of the respiratory system; diseases of the nervous system and sense organs; mental, behavioral, and neurodevelopmental disorders; diseases of the eye and adnexa; diseases of the ear and mastoid process.

6.4 ICD-10-CM Coding Practice, Part 4 

Infectious and parasitic diseases; diseases of the genitourinary system; pregnancy, childbirth, and the puerperium; conditions originating in the perinatal period; congenital malformations, deformations, and chromosomal abnormalities.

Unit 7: CPT/HCPCS and ICD-10-PCS Coding Practice

7.1 CPT/HCPCS Coding Practice, Part 1 

Introduction to CPT and HCPCS coding; CPT modifiers; evaluation and management services; medicine procedures.

7.2 CPT/HCPCS Coding Practice, Part 2 

Surgery coding; anesthesia procedures; digestive, endocrine, integumentary, musculoskeletal, and cardiovascular system procedures.

7.3 CPT/HCPCS Coding Practice, Part 3 

Hemic and lymphatic system procedures; mediastinum and diaphragm procedures; respiratory and nervous system procedures; eye and ocular adnexa procedures; auditory system procedures; operating microscope procedures; urinary, male genital system, reproductive, and intersex surgery procedures; female genital system and maternity care and delivery procedures; radiology services; pathology and laboratory services.

7.4 ICD-10-PCS Coding Practice, Part 1 

Purpose of ICD-10-PCS; coding manual organization and code structure; coding guidelines and steps; medical and surgical basics; coding for medical and surgical procedures.

7.5 ICD-10-PCS Coding Practice, Part 2 

Coding for procedures that remove a body part; that put in place or move a body part; that alter the diameter/route of a tubular body part; that remove solids, fluids, or gases; and that involve devices.

7.6 ICD-10-PCS Coding Practice, Part 3 

Coding overview, abstracting, character assignment, and code arrangement for medical and surgical-related procedures and ancillary procedures.

What You Get

  • Instant access to high-quality course materials
  • One-to-one mentorship from a professional in the field
  • Video training featuring tips from industry veterans
  • Certification preparation materials including free practice tests

The medical billing and coding program is designed to help students get started in this growing field. Study anytime, anywhere at your own pace and get certified in a matter of months. Call 1-800-239-9275 or enroll online today.