Medical Billing Online Course | Revenue Cycle Management
Learn Medical Billing Concepts, Charge Entry, Payment Posting, Denial Analysis, Accounts Receivable, AR Days, Follow-up
Description
In this Medical Billing Training course, you will learn the following points and much more: Parties Involved in Billing
Parties Involved in Medical Billing
Types of Providers
Types of Patients
Federal & Commercial Carriers
Primary, Secondary, Tertiary Insurance
Copay, Co-Insurance, Deductible & OOP
In -Network & OON
Types of Health Insurance plans (HMO, PPO, HDHP..)
MVA, WC , Self Pay
Medical Billing Cycle
Patient Scheduling , No Show
Insurance Verification
Patient Demography
Fee Schedule, Place of Service
Charge Posting, Cross over
EDI Enrollment
Clearing House, Claim Submission, Electronic & Paper
Billed, Allowed, Paid & Write off
ERA, EOB & Payment Posting, FFS, Capitation, With hold, Offset, Refund
Interest Payment, Late Charges, Medical Record Payment & NSF
Denial Scenarios
AR Analysis
AR Follow-up
Credit Balance Review
Patient Statements & Collections
Bad Debt
Bankruptcy
AR Days, Net Collection & Denial Rate
Reporting
Denial Analysis:
1) Patient & Demographic Based Denials:
Coverage / ID Problem
Waiting for Additional Info from Patient
Insurance Address Change
Patient Not in System
Pre-Existing Condition
2) Coding based Denials:
Procedure (CPT)/Diagnosis Problem
Included w/ Primary or Other Procedure
Included in Global Rules
Down Coding Explanation
Modifier Required
3) Payment Based Denials:
Inappropriate Payment Amount
Maximum Benefits Paid by Primary Ins
Refund Request
Overpayments
Withhold Amount
4) Provider Based Denials:
W9 Request
Physician / Group Info Needed
Need Physician Signature
Medical Records Needed
Not Medically Necessary
5) Other Denial Categories:
Insurance Needs Additional Info / Re Submit Claim
Need Copy of EOB
Need to Contact Ins Co. for further Info
Bankruptcy Letter Received
Attorney Requesting Information
Insurance Follow Up Scenarios:
Claim not on file
Claim in process
Claim Paid
Denied as Duplicate
Claim Pended
Additional info required from Provider
Additional info required from Patient
Claim denied for PCP Referal
Denied for authorization
Denied as Dx Code Inconsistent
Untimely Filing Denial
Provider not available with Insurance record
Third Party Pricing
OON
Claim paid to incorrect address
Claim Offset
What You Will Learn!
- Medical Billing Concepts, Job Opportunities in Medical Billing
- Parties Involved in Medical Billing
- Medical Billing Cycle
- Types of Insurances, Types of Health Insurance Plans, CMS1500, UB04
- Charge Entry, Payment Posting, Revenue Cycle Management, Accounts Receivable,
- Denial Analysis, Working on Unpaid Claims
- 16 Insurance Calling Scenarios
Who Should Attend!
- This course is for Graduates or the one who is interested to learn more on medical billing and willing to work for a Hospitals, Medical Billing Companies, etc.,