Course Outline

Module 1: Introduction to the US Healthcare System

• Overview of US healthcare models (Medicare, Medicaid, private insurance).

• Role of medical billing and coding professionals.

• Compliance and regulatory requirements (HIPAA, CMS).

Module 2: Medical Billing & Health Insurance Basics

• Health insurance types and payer systems.

• Patient eligibility and insurance verification.

• Understanding Explanation of Benefits (EOB).

Module 3: Medical Terminology & Anatomy for Billing

• Common medical terms and abbreviations.

• Body systems and their relevance in coding.

Module 4: Medical Coding Systems (ICD-10, CPT, HCPCS)

• Structure and application of ICD-10 for diagnosis coding.

• CPT procedural coding and HCPCS codes for medical services.

• Coding compliance and audit preparation.

Module 5: Claims Processing & Revenue Cycle Management

• Step-by-step medical claims submission process.

• Common claim errors and rejection handling.

• Managing denials, appeals, and resubmissions.

Module 6: Hands-on Training with Billing Software

• Navigating electronic health record (EHR) and billing platforms.

• Processing real-time claims using software.

Module 7: Provider Credentialing & Compliance

• NPI registration and provider credentialing with payers.

• Ethical considerations in billing and fraud prevention.

Module 8: Career Development & Certification Preparation

• Certification options (CPC, CCS, CBCS).

• Resume building and job search strategies.

• Networking and industry best practices.