Medical Billing Online Course | Revenue Cycle Management




Medical Billing Online Course | Revenue Cycle Management

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

Learn Medical Billing Concepts, Charge Entry, Payment Posting, Denial Analysis, Accounts Receivable, AR Days, Follow-up

Url: View Details

What you will learn
  • Medical Billing Concepts, Job Opportunities in Medical Billing
  • Parties Involved in Medical Billing
  • Medical Billing Cycle

Rating: 4.35294

Level: All Levels

Duration: 5.5 hours

Instructor: Murugesan Jeyaraj


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