1. Introduction to Medical Coding and Billing

• 1.1 Overview: Importance of coding and billing in healthcare.
• 1.2 Key Concepts: Definitions and terminology.

2. Medical Coding Systems

• 2.1 ICD Coding: International Classification of Diseases.
• 2.2 CPT and HCPCS Codes: Current Procedural Terminology and Healthcare Common Procedure Coding System.
• 2.3 Application: How coding is used for documentation and billing.

3. Medical Billing Procedures

• 3.1 Process: Overview of the billing cycle.
• 3.2 Claims Submission: Steps for accurate claim filing and reimbursement.
• 3.3 Compliance: Understanding regulations and avoiding common errors.

1. Introduction to Anatomy and Physiology

• Concepts: Overview of anatomy and physiology.
• Terminology: Key terms and definitions.

2. Body Systems Overview

• Skeletal System: Structure, bones, and joints.
• Muscular System: Muscle types and functions.
• Nervous System: Brain, spinal cord, and nerves.
• Cardiovascular System: Heart, blood vessels, and circulation.
• Respiratory System: Lungs and breathing mechanisms.
• Digestive System: Organs involved in digestion and nutrient absorption.
• Other Systems: Brief overview of additional systems like endocrine, urinary, and reproductive.

3. Integration of Body Systems

• Homeostasis: How systems work together to maintain balance.
• Health and Disease: Impact of dysfunction in body systems.

1. Basics of Medical Terminology

• 1.1 Structure: Understanding root words, prefixes, and suffixes.
• 1.2 Pronunciation: Correct pronunciation of medical terms.
• 1.3 Spelling: Importance of accurate spelling in medical terminology.

2. Common Medical Terms

• 2.1 Body Systems: Terms related to major body systems (e.g., cardiovascular, respiratory, digestive).
• 2.2 Diseases and Conditions: Terminology for common diseases and medical conditions.
• 2.3 Procedures and Treatments: Terms for diagnostic tests, surgeries, and treatments.

3. Application of Medical Terminology

• 3.1 Documentation: Using medical terminology in patient records.
• 3.2 Communication: Effective use of medical terms in verbal and written communication within healthcare settings.

1. Introduction to CPT Coding

• 1.1 Overview: Purpose and history of the CPT coding system.
• 1.2 Structure: Categories and sections of CPT codes.

2. CPT Code Structure

• 2.1 Sections: In-depth look at the six main sections (Evaluation and Management, Anesthesia, Surgery, Radiology, Pathology and Laboratory, Medicine).
• 2.2 Format: Understanding the five-digit code structure and modifiers.

3. Using CPT Codes

• 3.1 Code Assignment: How to select and assign the correct CPT codes.
• 3.2 Guidelines: Rules and guidelines for proper coding.
• 3.3 Documentation: Integrating CPT codes into medical records and billing.

4. Advanced Coding Topics

• 4.1 Modifiers: Applying CPT code modifiers for specific scenarios.
• 4.2 Updates: Keeping up with annual CPT code changes and updates.
• 4.3 Compliance: Ensuring accurate and compliant coding practices.

1. Introduction to HCPCS

• 1.1 Overview: Purpose and scope of the HCPCS coding system.
• 1.2 Levels: Understanding HCPCS Level I (CPT codes) and Level II codes.

2. HCPCS Level I (CPT Codes)

• 2.1 Integration: How CPT codes fit into the HCPCS system.
• 2.2 Application: Using Level I codes for reporting medical procedures and services.

3. HCPCS Level II

• 3.1 Structure: Overview of alphanumeric codes (A-V codes).
• 3.2 Categories: Durable medical equipment (DME), supplies, and other services.
• 3.3 Assignment: How to select and apply Level II codes.

4. Coding Guidelines and Compliance

• 4.1 Coding Rules: Specific rules for applying HCPCS codes.
• 4.2 Documentation: Properly documenting services and equipment using HCPCS codes.
• 4.3 Compliance: Ensuring accurate and compliant coding practices.

• Introduction to ICD-10: Overview and significance.
• Code Structure: Format and categories of ICD-10 codes.
• Coding Guidelines: Rules for selecting and sequencing codes.
• Application: Using ICD-10 codes in documentation and billing.
• Compliance: Ensuring accuracy and staying updated with revisions.

• Introduction to Reimbursement: Overview of payment systems in healthcare.
• Fee-for-Service (FFS): Traditional model of reimbursement based on services provided.
• Capitation and Bundled Payments: Alternative payment models focused on cost efficiency.
• Prospective Payment Systems (PPS): Understanding DRGs, APCs, and other PPS models.
• Coding and Billing: Role of ICD-10, CPT, and HCPCS codes in reimbursement.
• Compliance and Audits: Ensuring adherence to regulations and preventing fraud.

• Introduction to Medical Billing: Overview of the billing cycle and key stakeholders.
• Patient Registration and Data Entry: Gathering and entering accurate patient information.
• Insurance Verification: Confirming coverage and benefits before services are rendered.
• Claim Submission: Preparing and submitting claims using electronic and paper formats.
• Claim Processing: Understanding the steps involved in payer processing and adjudication.
• Denials and Appeals: Managing denied claims and the appeals process.
• Reimbursement: Receiving and posting payments, and managing accounts receivable.
• Compliance and Regulations: Ensuring adherence to billing guidelines and legal requirements.

• Introduction: Importance of compliance and ethical standards.
• Regulations: Key regulations and documentation standards.
• Ethical Issues: Principles, fraud prevention, and reporting violations.
• Compliance Programs: Implementing training and audits.