Master Medical Billing & Revenue Cycle Management: A Complete Guide

What you will learn:

Gain a comprehensive understanding of the US healthcare system and revenue cycle management (RCM).
Master the entire medical billing lifecycle, from patient registration to payment posting.
Develop expertise in various insurance plans (Medicare, Medicaid, private insurance) and their billing implications.
Become proficient in claim processing, denial management, and maximizing reimbursements.
Build a strong foundation for a successful career in medical billing, RCM, or healthcare operations.

Description

Launch your healthcare finance career with confidence! This comprehensive course provides a step-by-step guide to mastering medical billing and revenue cycle management (RCM). Whether you're a complete beginner or looking to enhance your skills, this program equips you with the in-demand expertise needed to succeed in the healthcare industry.

This course goes beyond the basics: You will learn the intricacies of the U.S. healthcare system, navigate various insurance plans (Medicare, Medicaid, private insurance, and more), master medical coding (ICD-10, CPT), accurately create and submit claims, efficiently manage accounts receivable (AR), tackle denials and appeals, and master payment processing. We'll cover everything from understanding the 12 key steps in the medical billing cycle to utilizing practice management systems for optimal workflow.

Here's what awaits you:

A foundational understanding of the U.S. healthcare system and its financial intricacies.
A clear distinction between RCM and medical billing, and how they interact.
Proficiency in verifying patient eligibility and benefits, crucial for accurate billing.
Comprehensive knowledge of medical coding essentials (ICD-10, CPT codes, modifiers) and their impact on reimbursements.
Expert strategies for claim creation, submission, denial management, and appeals, ensuring prompt and accurate payments.
Effective methods for managing accounts receivable (AR), maximizing collections, and minimizing outstanding balances.
In-depth understanding of payment posting processes, EOBs, ERAs, and EFT for timely reimbursement.
Hands-on experience with practice management systems and clearinghouses.

By the end of this course, you'll be a confident and competent professional ready to tackle any challenge in the dynamic world of healthcare finance. Enroll today and unlock your potential!

Curriculum

Introduction to Revenue Cycle Management and the US Healthcare System

This section lays the groundwork for your RCM journey. You'll define RCM, explore the structure of the US healthcare system, understand the roles of key players, and differentiate between RCM, medical billing, and coding. Lectures cover essential topics including the impact of health insurance on revenue cycle management.

Medical Billing Cycle Overview

Gain a comprehensive grasp of the 12 key steps within a typical medical billing cycle. This overview establishes a strong foundation for understanding the entire billing process from start to finish.

Insurance Basics in Medical Billing

This section delves into the intricacies of various US insurance plans. You'll learn about Centers for Medicare & Medicaid Services (CMS), explore different insurance types (Medicare, Medicaid, Tricare, private plans), understand eligibility criteria, and differentiate between HMO, PPO, and POS plans. The impact of these plans on medical billing and referral requirements is comprehensively covered.

Insurance Eligibility and Benefits

Master the art of patient verification. You'll learn how to verify insurance eligibility, understand patient demographics, navigate the benefits verification process, interpret key terminologies, and manage referrals and prior authorizations effectively.

Medical Coding Essentials

This section provides an in-depth understanding of medical coding. You'll learn about ICD-10 and CPT codes, including modifiers and units. The section further explores the relevance of NCCI, LCD, and NCD in medical billing to ensure accurate coding practices.

Providers and Facilities

Learn to identify and classify healthcare providers and facilities, understand place-of-service and type-of-service codes, and gain a comprehensive understanding of different healthcare provider types and their roles within the billing process.

Claim Creation and Practice Management Systems

This section focuses on claim creation using the HCFA 1500/CMS 1500 form and the 837P format. You'll learn about key boxes on the CMS 1500 form and understand the functions of practice management systems in streamlining the billing process.

Claim Submission Process

Master the claim submission process, including the role of clearinghouses, batch submissions, timely filing limits, and effective strategies for successful submissions. You'll also learn to understand and address claim rejections.

Accounts Receivables (AR) and Follow-Up

This section covers effective accounts receivable management. You'll learn about different AR follow-up methods, understand aging buckets, and implement best practices for efficient collections and the use of automation tools.

Denial Management and Appeals

Learn strategies for handling claim denials and rejections. This section emphasizes the difference between denials and rejections, and covers the appeal writing process to ensure timely reimbursements.

Payment Processing in RCM

This final section focuses on payment posting, understanding EOBs and ERAs, EFT setup, and comparing manual versus automatic payment posting methods for efficient and accurate payment processing.

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