Medical Billing and Coding Course Curriculum

The comprehensive curriculum of Blackstone’s online Medical Billing and Coding course covers a broad range of topics.

Unit I: Blackstone Skills for Success

Chapter 1

Covers learning styles; instrinsic versus extrinsic motivation; self-efficacy and self-determination; visual, auditory, and kinesthetic learners; and field dependence versus field independence.

Chapter 2

Covers study skills, including choosing a place to study; scheduling time, goal setting; monitoring your study sessions; and avoiding procrastination.

Chapter 3

Covers learning strategies, including SQ3R; note-taking skills; memory tricks; references; and how to take multiple choice tests.

Unit II: Introduction to Computers, Keyboarding and Office Technology

Chapter 1

Covers how computers are used in the office today, the different types of computers, and the parts of a computer system.

Chapter 2

Covers basic keyboarding skills using Blackstone’s Online Typing Tutor.

Chapter 3

Covers the Internet, the World Wide Web (WWW), URLs, the different types of Internet connections, search engines, email, and other uses for the Internet.

Chapter 4

Covers other types of office technology including office telephones, the different types of telephone calls, fax machines, photocopiers, multipurpose machines, transcribers, digital cameras, and wireless communication.

Unit III: Anatomy and Medical Terminology 1: An Introduction

Chapter 1

Explains how medical terms are constructed and analyzed to determine meaning; discusses types of medical terms; explains the function of combining vowels and how terms are pluralized.

Chapter 2

Covers prefixes relating to number, size, color, negation, position and direction, as well as those with the same meaning or opposite meaning.

Chapter 3

Covers common roots and combining vowels as well as suffixes which indicate the word’s part of speech; also discusses suffixes related to pathologic conditions, diagnoses, and surgical incisions.

Chapter 4

Introduces the body cavities, body planes, and directional terms.

Unit IV: Anatomy and Medical Terminology 2

Chapter 5

Discusses the anatomy and physiology of the skeletal system, including the bones; the axial and appendicular skeletons; and the joints and ligaments; also provides a list of relevant medical terms.

Chapter 6

Covers the muscular system, including the types of muscles and their functions, and related diseases and disorders; lists relevant medical terms.

Chapter 7

Provides and overview of the integumentary system, including the skin, hair and nails; discusses diseases and disorders as well as lists relevant medical terms.

Chapter 8

Covers the respiratory system—including the nose, pharynx and lungs—as well as diseases and disorders related to this system; lists relevant medical terms.

Unit V: English Usage and Written Communication

Chapter 1

Covers the parts of speech, including nouns, verbs, pronouns, adjectives, adverbs, prepositions, conjunctions, and interjections.

Chapter 2

Covers the parts of a sentence, including the subject, predicate, direct and indirect objects, subject complements, phrases, and clauses.

Chapter 3

Covers pronoun/antecedent agreement and pronoun usage; explains how pronouns are used in sentences; covers subject/verb agreement.

Chapter 4

Covers sentence types and sentence punctuation.

Chapter 5

Covers fundamentals of written communication, including using active versus passive voice, writing unified and coherent paragraphs, and writing topic sentences for paragraphs. Discusses common types of business communication, including business letters and memorandums.

Unit VI: Anatomy and Medical Terminology 3

Chapter 9

Covers the cardiovascular system, including the structure of the heart, function of blood vessels, and related disorders and diseases; lists relevant medical terms.

Chapter 10

Discusses the function and parts of the urinary system, including kidneys, ureters, bladder, and urethra; covers related diseases and disorders as well as medical terminology.

Chapter 11

Introduces the digestive system, including the oral cavity, pharynx, esophagus, stomach, intestines, and accessory organs; covers related diseases and disorders as well as medical terminology.

Chapter 12

Covers the peripheral and central nervous systems, their function, related diseases and disorders, and medical terminology.

Unit VII: Anatomy and Medical Terminology 4

Chapter 13

Discusses the glands that make up the endocrine system as well as related diseases and disorders; also lists relevant medical terms.

Chapter 14

Provides an overview of the anatomy of both the eyes and the ears (the sensory system); covers related diseases and disorders as well as medical terminology.

Chapter 15

Covers the blood, lymphatic, and immune systems and their functions; discusses relevant diseases and disorders as well as medical terminology.

Chapter 16

Provides an overview of both the male and female reproductive systems; covers related diseases and disorders as well as medical terminology.

Unit VIII: Introduction to Pharmacology

Chapter 1

Covers consumer safety and drug regulations; discusses drug laws, the FDA, DEA, and laws affecting healthcare workers.

Chapter 2

Covers drug names and references; discusses classifications, drug names, legal terms relating to drugs, and terms indicating drug actions, drug references, and drug cards.

Chapter 3

Covers sources and bodily effects of drugs; discusses how drugs are processed by the body; explains absorption, distribution, metabolism, excretion, and other variables, and unexpected responses to drugs.

Chapter 4

Covers medication preparation and supplies; discusses standard drug forms and supplies.

Chapter 5

Lists and discusses abbreviations and systems of measurement.

Unit IX: Professional Development and Medicolegal Ethics

Chapter 1

Discusses concepts of professional development including attitude, self-esteem, professional attire, business etiquette, verbal and nonverbal communication, introductions, time and stress management, and continuing education.

Chapter 2

Discusses medicolegal ethics in healthcare; covers the code of ethics; discusses aspects pertaining to the healthcare record including the purpose of ownership, how to correct mistakes, the difference between privileged and nonprivileged information, and the importance of timeliness.

Unit X: Introduction to Insurance Billing and Coding 1

Chapter 1

Covers the roles and responsibilities of the health insurance specialist; discusses medical billing and coding employment opportunities, basic skill requirements, and professional certification.

Chapter 2

Gives an introduction to health insurance; defines health insurance; discusses disability and liability insurance and the major developments in health insurance, health insurance coverage statistics, and third-party reimbursement methods.

Chapter 3

Discusses managed health care and its history; presents six managed care models; discusses the accreditation of managed care organizations, government managed care ventures, and the effects of managed care on administrative procedures in a physician’s practice.

Chapter 4

Explains the life cycle of a medical insurance claim including the development of the claim, the new patient interview and check-in procedure, an established patient return visit, and post clinical check-out procedures; explains how insurance companies process claims and how insurance claim files are maintained.

Chapter 5

Covers the legal and regulatory considerations; explains confidentiality of patient information; discusses the retention of patient information and health insurance records, the Federal False Claims Act, and the Health Insurance Portability and Accountability Act of 1996.

Chapter 6

Covers ICD-9-CM coding, including HCFA ICD-9CM coding guidelines, primary and principal diagnosis coding, principal versus secondary procedures, and coding qualifying diagnoses; explains the basic steps for using the index and the organization of the tabular list; discusses considerations to ensure accurate ICD-9-CM coding.

Chapter 7

Covers CPT coding; discusses the CPT coding system, format, symbols, conventions, and index; explains the basic steps for coding procedures and services.

Unit XI: Introduction to Insurance Billing and Coding 2

Chapter 8

Covers the HCPCS Coding System; explains how this system is organized; gives HCPCS national (Level II) codes and how these codes are assigned; explains how HCPCS national (Level 11) modifiers are assigned.

Chapter 9

Discusses HCFA reimbursement issues; explains the Medicare fee schedule, and HCFA regulations that impact reimbursement.

Chapter 10

Covers coding from source documents; explains how to apply ICD-9-CM coding guidelines; discusses CPT/HCPCS billing considerations; gives coding clinical scenarios; discusses how medical and operative reports are coded.

Chapter 11

Gives essential HCFA-1500 claim form instructions, general billing guidelines, and optical scanning guidelines; discusses the reporting guidelines and restrictions covering the following claim form items: diagnoses, date entry, procedures, modifiers, charges, diagnostic reference numbers, and units; explains why the billing entity’s employer tax identification number (EIN) should appear on the claim; explains the four processing steps that must occur before a completed form can be mailed to the insurance company; discusses how to set up a tickler filing system for completed claim forms.

Chapter 12

Discusses how commercial claims are filed; explains how to determine the status of primary and secondary commercial claims; explains how to complete commercial primary and secondary fee-for-service claims and commercial primary supplemental fee-for-service claims accurately; explains how to create a comparison chart as an aid to mastering the details of completing claim forms.

Unit XII: Introduction to Insurance Billing and Coding 3

Chapter 13

Covers Blue Cross and Blue Shield plans; explains the function of the national Blue Cross and Blue Shield (BCBS) Association; lists four distinctive features that make the BCBS plans different from other commercial medical insurance programs; compares and contrasts the advantages of being a BCBS participating provider versus being a non-participating provider; describes the features of BCBS basic benefits; lists typical services found in Major Medical coverage; explains the benefits of special accidental injury riders/clauses.

Chapter 14

Covers Medicare; discusses medical eligibility, enrollment, Part A and Part B coverage, participating providers and nonparticipating provider restrictions; gives step-by-step claim form instructions; discusses situations where Medicare is the secondary payer.

Chapter 15

Covers Medicaid; presents the legislative background of Medicaid and Federal eligibility requirements; discusses Medicaid services and the relationship between Medicaid and Medicare; discusses situations where Medicaid is the secondary payer.

Chapter 16

Covers TRICARE; presents TRICARE administration, options, programs and demonstration projects and service centers; discusses preauthorization, limited charges, supplemental plans, and billing information; gives primary claim instructions and secondary payer claim instructions.

Chapter 17

Covers workers’ compensation; discusses Federal compensation programs and state-sponsored coverage, eligibility, and classification of on-the-job injuries; explains the OSHA Act of 1970 and the special handling of workers’ compensation cases, first report of injury, progress reports; gives claim instructions.

Unit XIII: Medical Office Practice 1

Chapter 1

Introduces medical informatics, or the use of computers and computer information technology in health care, and issues related to the privacy and security of medical information.

Chapter 2

Introduces the Windows environment and its terminology.

Chapter 3

Covers the use of MediSoft in the medical office, including relevant terminology, the use of various coding systems, the role of MediSoft in accounting, the claims submission process, and MediSoft’s various accounting reports.

Chapter 4

Introduces the MediSoft and Office Hours windows and toolbars, as well as entering appointments and printing an appointment schedule.

Unit XIV: Medical Office Practice 2

Chapter 5

Covers entering patient and case information in MediSoft, as well as editing, saving and printing information.

Chapter 6

Describes transaction entry, including entering, editing and applying payments and charges. Also covers claim management, printing a Deposit List report, and checking on a patient’s billing status using Quick Ledger and Quick Balance.

Chapter 7

Explains the process of submitting electronic claims and the function of a clearinghouse.

Unit XV: Medical Office Practice 3

Chapter 8

Provides an overview of the kinds of reports produced in MediSoft, including day sheets, aging reports, patient statements, patient ledgers and analysis reports.

Chapter 9

Discusses using the custom design grid to create several types of reports.

Chapter 10

Covers establishing a new practice database and entering practice, provider, address, and patient information, as well as insurance carriers, several types of codes, patient profiles, and cases and transactions.

Chapter 11

Discusses MediSoft’s file maintenance and backup utilities.

Unit XVI: Practical Applications of Coding 1

Chapter 1

Provides an introduction to medical coding including careers; required skills; fraud and abuse; tools of the trade; and the types of coding.

Chapter 2

Covers ICD-9-CM coding, including history and use; V, E, and M codes; categories, subcategories and subclassifications; coding conventions; basic steps; coding for infections, diabetes, obstetrics, neoplasms, injuries, complications and late effects. Also discusses the implementation of the ICD-10-CM.

Chapter 3

Covers HCPCS II coding, including history; format; hierarchy; code revisions; the index; accuracy tip; and a medication flow chart.

Chapter 4

Covers CPT coding basics, including symbols; unlisted codes; illustrations; anesthesia; surgical guidelines; radiology and pathology guidelines; category II and III codes; errata; and tips for selecting the correct code.

Chapter 5

Covers evaluation and management codes, including guidelines and criteria; selecting the E/M code for the most common procedures; CMS 1995 and 1997 E/M guidelines; and the CPT code book.

Chapter 6

Covers coding for anesthesia and general surgery, including a review of body systems and procedures performed. Discusses the application of physical status modifiers.

Chapter 7

Covers coding for the integumentary (skin) system, including assigning ICD-9-CM diagnosis codes and CPT procedure codes. Discusses official coding guidelines and provides common terms related to disorders of the skin and dermatology procedures.

Chapter 8

Covers the proper application of coding rules and conventions for the ICD-9-CM and CPT systems as applied to orthopedics. Explains the most common disease and disorders of the musculoskeletal system, including fractures, dislocations, sprains and strains, and bone infections.

Unit XVII: Practical Applications of Coding 2

Chapter 9

Covers the many facets of the modern cardiology practice and applicable coding guidelines. Includes basic cardiac anatomy and terminology as well as non-invasive and invasive procedures.

Chapter 10

Discusses obstetrics and gynecology, including a review of female reproductive anatomy and physiology as well as OB/GYN terminology, and assigning the proper ICD-9-CM and CPT codes.

Chapter 11

Covers specialized coding in radiology, pathology and laboratory procedures. Discusses diagnostic imaging, ultrasound, radiation oncology and nuclear medicine.

Chapter 12

Reviews the Medicine chapter in the CPT and covers identifying the variety of service categories in the CPT. Discusses the modifier rules for the codes in these series.

Chapter 13

Covers proper medical billing techniques and the collection of payment in the outpatient setting. Includes patient registration and preparation of the ledger card. Discusses ambulatory patient groups, cycle billing, monthly billing and computerized billing, and collection techniques.

Chapter 14

Focuses on the completion of the CMS-1500 claim form for commercial and government insurance carriers. Also covers various types of insurance, including Medicare, Medicaid, HMOs, CHAMPUS, TRICARE, CHAMVA, Blue Cross/Blue Shield, and Workers’ Compensation.

Chapter 15

Covers the typical payment cycle for physician office services and defines multiple processes that affect financial results. Includes auditing, appeals and the Health Insurance Portability and Accountability Act (HIPAA).

Chapter 16

Provides an overview of in-patient hospital-based medical billing. Covers hospital based ICD-9-CM coding and guidelines. Discusses the inpatient prospective payment system.

Unit XVIII: How to Find a Job in Healthcare

Chapter 1

Covers medical billing and coding job-search correspondence, including resumes and cover letters.

Chapter 2

Discusses job-search techniques such as networking and using online employment search engines.

Chapter 3

Discusses job interviews; explains how to dress for an interview, what to bring to an interview, what to expect during an interview; discusses common questions asked during a job interview and how to follow up after an interview