Overview:
This course covers the fundamentals of medical billing, coding, and reimbursement by explaining how all of these components work together. Emphasis will be placed on the practical application of the latest industry knowledge and standards, with the goal of helping those who work with medical claims and claims data stay ahead of the game.
This course covers the fundamentals of medical billing, coding, and
reimbursement by explaining how all of these components work together.
Emphasis will be placed on the practical application of the latest
industry knowledge and standards, with the goal of helping those who
work with medical claims and claims data stay ahead of the game.
Participants will learn about the following:
- The claim flow process from registration through adjudication and payment
- How physicians and hospitals set and manage charges
- Critical data elements on the two major claim forms and what they mean
- How and why the major coding systems are utilized
- How various reimbursement methods are used by payors
AAPC Continuing Education Units Available.
This program meets AAPC guidelines for 6.0 Core A continuing education units.
Why you should Attend:
This course is organized into three sections: The life cycle of a claim, coding systems, and reimbursement.
Life cycle of a claim
Many
people understand a portion of the claim adjudication process, but they
may not have a complete understanding of all steps necessary to
generate and adjudicate claims. We walk through the entire life cycle
of a medical claim, from patient registration through provision of
services, from claim generation to adjudication, from payment to
posting. This is useful for anyone new to the healthcare industry or
for persons who want a more complete understanding of the entire claim
life cycle.
Coding systems
Medical coding is the foundation of
the US healthcare system. Medical codes are essential for billing and
claims, reimbursement, healthcare analytics, risk scoring, physician
compensation, among many other uses. Every claim includes multiple
codes from various coding systems. In this course, we explain the use
of five of the most common schemes in use today: CPT and HCPCS codes,
ICD-10 codes, DRGs, and APCs.
For each system, we discuss how
codes are assigned; where they appear on the claim; how they are used
for billing and reimbursement; which types of claims are subject to each
coding scheme; and other features of each system. We also provide tips
for analyzing data containing these codes.
Reimbursement explained
Healthcare
reimbursement systems can be complex and difficult to understand. Each
payor may use a different method to reimburse providers, or they may
use a variation of a commonly used method. In the third portion of this
course, we discuss the common reimbursement systems in use today. We
start with Medicare's reimbursement systems of RBRVS, DRGs, and APCs
because many other payors use modified versions of these systems. We
then discuss other payor types such as HMOs, PPOs, and ACOs and how
these organizations use other reimbursement methods such as capitation,
per diems, and carve outs. Finally, we discuss the key data elements
needed to adjudicate claims according to each scheme, and we discuss the
financial incentives (and disincentives) associated with each method.
Who Will Benefit:
- Health Information Managers
- CFOs
- Medical Billers
- Analysts
- Physicians and other Medical professionals
- Provider Contract Managers
- Medical Coders
- Claim Examiners
- Reimbursement Directors
- Payment Integrity Managers
- Quality Managers and Revenue Managers