Medical Billing/Revenue Cycle (v.02)
Issued by
Madison College
Medical billing is the process of completing tasks throughout the medical revenue cycle leading to maximum, appropriate, and timely payment for patients’ medical services. Recipients of this badge have a solid understanding of healthcare insurance, medical coding, claims requirements, processing payments, and effective collection efforts. Earners are prepared to take the National Healthcareer Association’s Certified Billing and Coding Specialist (CBCS) exam upon graduation.
Skills
Earning Criteria
-
Knowledge of healthcare laws (HIPAA, HITECH) and HMOs, PPOs, consumer-driven health plans, medical insurance payers
-
Determine new vs. established patients and primary insurance payer
-
Correctly assign ICD-10 diagnostic codes, CPT procedural codes and HCPCS codes
-
Knowledge of billing rules and compliance
-
Understand physician fees and capitation
-
Prepare insurance claim forms like CMS-1500 and HIPAA 837P
-
Knowledge of private payers, Medicare, Medicaid, military programs, worker's compensation
-
Earn an average of 90% or above on associated assessments
Standards
The skills learned through the NHA CBCS certification are essential to hospitals, physician offices, surgery centers, nursing homes, dental offices, home healthcare agencies, mental health facilities and even insurance companies and consulting firms.